Searching for Cause of Morocco’s High Breast Cancer Rates
Breast cancer rates are rising in Morocco, and cases are being diagnosed at earlier ages and later stages. Inflammatory breast cancer, the most aggressive form of locally advanced breast cancer, is also more common throughout North Africa than in Europe or North America.
“We’re wondering why,” says MPH student Samantha Fortier. For her practicum, Fortier is spending the summer at the Ibn Rochd University Hospital in Casablanca, analyzing the city’s cancer registry data to create a clearer picture of locally advanced breast cancer in Morocco.
Locally advanced breast cancer (LABC) is cancer that has spread beyond the breast to the chest wall or the skin of the breast, or to lymph nodes in the underarm area, but not to other organs. The project is a pioneer study, Fortier says, following the earlier, smaller studies that suggested LABC is particularly prevalent in Morocco.
Fortier is using the Casablanca population registry to describe and estimate incidence rates, clinical and demographic characteristics, and age-specific incidence of LABC in women. She is also looking to see if LABC cases cluster in certain geographic regions or neighborhoods of Casablanca.
“We’re doing the pioneer work to find patterns,” Fortier says, “so later on we can say why locally advanced breast cancer is prevalent here in Morocco.” That in turn will help the country’s breast cancer prevention efforts, she says, which since the early 2000s have been spearheaded by the royal family.
The practicum is supported by the Cancer Epidemiology Education for Special Populations (CEESP) fellowship from the College of Public Health at the University of Nebraska and the National Institutes of Health (NIH). The program connects students with mentors to design and work on projects around cancer epidemiology in minority or international populations. Fortier and Emily Auwarter are the first BU students to receive CEESP fellowships, which were previously offered only to students at the University of Nebraska and the University of Michigan.
Fortier’s advisors on the project are Amr Soliman, who directs CEESP at the University of Nebraska, and Megan Healey, clinical assistant professor of epidemiology.
“It’s a great experience to learn what’s actually feasible,” Fortier says of designing and leading her own project through the CEESP program. Working with these advisors makes her more confident, she says, as she applies what she learned at SPH to a pioneer study. “This is my first time beginning work, instead of having existing articles to build on,” she says. “It’s exciting to have these conversations, and to train in epidemiology with a lot of missing data and missing variables.”
Fortier says her colleagues at Ibn Rochd University Hospital have also been amazing resources. “We all have different projects, but if any of us need help we definitely do ask,” she says. “We’re trying to learn from each other.”
That learning goes beyond research. “I’ve told my co-workers that if I don’t say a few words—‘Good morning,’ or ‘Hi,’ or ask a question—in Arabic, then they can’t respond to me until I try it, just to force me out of my comfort zone and learn more Arabic,” she says. Her Moroccan colleagues have also been showing Casablanca to her and other foreign researchers, and teaching them about Moroccan culture. “It’s a real honor to meet and work with these great colleagues, and to see the country through their eyes,” she says.
Samantha Fortier is taking over the SPH Instagram account from August 14 through 18 to share photos from Casablanca. Follow along at Instagram.com/BUSPH/.