First Emirati Breast Surgeon Fighting Against Breast Cancer

Dr. Houriya Kazim, is the first Emirati female surgeon and the first Emirati surgeon specializing in breast surgery, she carries deep passion for saving lives and raising awareness about breast cancer. Through her extensive experience with patients, she has not only provided medical treatment but also offered the psychological support and guidance women need when facing this disease.

In this special interview, Houriya shares her journey and impactful experiences with breast cancer patients, revealing the challenges and accomplishments she has encountered throughout her medical career.

Dr. Houriya, how would you describe your experience working with breast cancer patients?

My experience with breast cancer patients has been very emotional. Some people find it difficult to cope. I mean, I've literally had patients run out into the road and try to jump in front of a moving car or jump out of a window.

• Tell us about your career path and your experience as the first Emirati surgeon.

I am Dr. Houriya Kazim, I am the first Emirati surgeon, I'm actually a breast surgeon. And I am the president and founder of “Breast Friends”, which is a charity and support group for breast cancer patients.

• How did you start in this field?

When I came back to Dubai as an intern, I was working at Rashid Hospital, and that is where I first started seeing really advanced cases of breast cancer. So, as I said, at that point, I wasn't a trained surgeon, but I was part of the surgical medical team.

• Did you face challenges when dealing with patients?

Yes, a lot of the women who came in with these advanced breast cancers didn't want the male consultant to examine them or any of the other male members of the team. They would prefer me, as you know, on the lowest rung of the ladder to examine them. Rather than the male.

“The Impact of Culture and Shame on Early Breast Cancer Detection”

• What was your experience like during patient examinations?

What would happen is I would be on the inside of the curtain with the patient, and then the consultant would be on the other side, and I would have to describe what I saw, what I felt on examination, and then he would say, “Okay, does she need surgery?” And of course, I had no idea I was an intern at that time.

• What did you notice repeatedly about breast cancer cases?

The thing that really struck me was how advanced these cases are. And if you think about where the breast is on your body, if something is advanced, you know it's right under your nose, it's right under your eyes, you know? And I couldn't imagine how these women, they must know it's there. It's not hidden in your tummy, you know what I mean?

• Why do you think some women delay seeking treatment?

Half of it is, is modesty. You know, we don't want to take our clothes off in front of a male surgeon. The other part is fear. So because women were presenting late, because of the modesty, because they don't want to go to a male surgeon, they leave it until it's so late.

• How can we change the culture surrounding breast cancer?

I thought well, I can do something about, at least initially, not having a woman surgeon. It was one of the things that really pushed me, the death of these women who I felt didn't need to die, and raising national awareness about this disease became crucial.

“The Battle for Breast Cancer Awareness”

• How did you begin raising awareness about breast cancer?

So I went out and I did talks to women's groups, to schools, and to colleges. Luckily, at the exact same time was when the internet was blooming. So young people were now getting information, taking it home to their moms and their grandmothers, so the information was getting out there.

• What kind of environment do you create to empower women?

I started the Well Woman clinic, and it's only women, it's staffed by women, and it's only for women. We’ve made the clinic look like a living room, so you feel like you're not in a hospital, and it's not clinical, and it's not scary.

• What were your steps on this path?

It wasn't like I had a plan to be honest from the beginning, but it was something that as I saw, there was a need. I thought, right. If there was something I thought I could do, I'll do it.

• Is there a difference between hearing real survivors’ stories and finding information online?  

Of course, so what I started doing was taking with me cancer survivors and especially local cancer survivors, because if you can see someone who looks like you, who has had cancer, but who also has a family who may have a job as well, and they've done their cancer treatment and they look absolutely normal and life's gone on and I think that is a powerful message.

• How can we change the negative perception of breast cancer?

We must emphasize that cancer does not necessarily equal death, especially if caught early. This has remained our core message to this day.

• Is the screening process difficult?

Yes, screening is a difficult one. It means you’re looking for something in someone who appears healthy, which isn’t easy.

• What happens if a woman comes with a lump?

If a woman comes in and she has a lump, all the tests we do are diagnostic, this is not screening. Screening is if a woman comes in, she's absolutely fine, but she wants to check that everything is in fact fine.

• At what age does screening start in different countries?

If you look at population screening, for example, in America, in Europe, in the UK, the age that they start screening in the US, they advise from the age of 40, in the UK they do it at the age of 50. Some of that might be because the government is paying for the screening.

• How does the average age of diagnosis impact screening procedures?

The average age of breast cancer diagnosis in North America and Europe is in the early 60s, while in the Middle East, it’s around 45, meaning we start screening two decades earlier than the rest of the world.

• Should we begin screening at age 25 or 30?

When I say screening, I mean mammograms for the breast, which are X-rays of the breast. So if our median age is 45, are we going to start at 25? Are we going to start at 30? It's crazy because when you're young your breasts are young.

• Why do breasts change with age?

As you get older, it shrinks, and it gets replaced by fat. We like fat because the X-rays penetrate very well.

• How does breast density affect screening results?

If you have dense breasts, which is normal in young people, though some older people can have dense breasts, the X-rays don't penetrate well.

• What do you do in your practice to address this?

What I do in my own practice is I individualize it. So I take each patient and use algorithms and equations where I can put in various risk factors that an individual will have. What age she had, her first period, did she have children?

• How do you handle patients who come to see you?

I’ve learned that much of what I do is psychological care. everybody who comes to see me thinks they're dying of cancer.

• What do you do to ease their anxiety?

My job is to reassure them and make them feel comfortable and confident.

• Are there specific risk factors?

Yes, known risk factors include smoking and alcohol consumption. However, we ensure patients don’t feel ashamed.

• How do you handle the idea that cancer is linked to lifestyle choices?

Everybody knows people who've smoked two packs a day, and they lived till they were 80 or 90 years old. And we all know people who've died of lung cancer when they're in their 40s.

• What is the impact of stress and pollution on breast cancer?

Pollution is a big one because we know that breast cancer is higher. The more developed a country is, the more breast cancer we see.

• How can people address risk factors?

We can manage habits like drinking alcohol and address stress and anxiety.

• What do you usually do during a screening?

When we do a screen, we usually do a screening mammogram. Sometimes we'll add ultrasound, sometimes we add MRI.

• What are the best ways to screen breast cancer?

The mammogram is probably the best in terms of picking up breast cancer, but it's not 100%. Nothing in medicine is.

• What happens if something is found during screening?

We don't usually do anything about it, unless this means a lump with water inside. We don't usually do anything with those, they're harmless. They don't usually turn into cancer, and unless it's large or causing pain or something, we don't do anything about it.

• What about solid lumps?

If we find a solid lump, because cancers come as a solid lump. Well, as I said earlier, the majority of solid lumps are not cancer, so at least 90% of those solid lumps that we see are benign, meaning harmless there.

• How important are medical screenings like mammograms and cervical tests?

We need to be proactive about our health. So part of that is having screening mammogram. Part of that is recognizing when something is wrong with your body, or at least knowing your body, so that you recognize when something is wrong. If you notice a lump or a bump or a mole that wasn't there, you know the last time you looked and you know, the number of times that I have seen that I've given talks in companies where women who should be well informed, young people who they know better, have come up to me and said, oh, I found a lump about six months ago, and I'm like, six months and you haven't done anything?

• Is there a health risk from radiation exposure during mammograms?

People don't realize that when you sit here, we have radiation around us. When you fly, you have a huge amount of radiation, the ambient radiation in the atmosphere. If you fly from Dubai to New York and back, you get a mammogram worth of radiation. Okay. So, you get radiation, and it's in food. It's in so many different things, you know. So, it's not just in mammograms. Obviously as medical practitioners, not just with mammograms, even with CT scans, radiation a lot of things that we do, it's done with ionizing radiation. And as I mentioned earlier, ionizing radiation, the effects of it are cumulative.  

• What is the relationship between detecting lumps in the breast and performing biopsies?

Another myth that that I get is, they don't women, when they find a lump, they don't want to do a needle biopsy because you're going to spread it. Right. And this one you can actually see, I mean, in your brain, if you think about it, you can visualize, I'm poking this thing and it's going to like, burst and go everywhere. They've actually looked at this, and it doesn't happen.

• Should women fear losing their breasts if cancer is detected?

Having first degree with relatives will put your risk up. But having a genetic mutation that you've inherited really puts your risk up.

• How can genetic mutations affect cancer risk?

Having a genetic mutation that you've inherited that really puts your risk up. So, we know a mutation is a mistake in your DNA. We have lots of them. Thankfully most of those mistakes don't translate into disease, but some of them do. And we know of many mutations that cause different types of cancer.