Issue 3, 2012. June-July



In honor of the annual Race for the Cure event in Tbilisi, Allison Dvaladze- who wrote her Master's on Public Health thesis on cancer in Georgia, and Keti Khukhunashvili report about how Corporate Social Responsibility (CSR) can help Georgian women survive breast cancer.

Allison Dvaladze and Keti Khukhunashvili

Breast cancer is survivable.

But women are dying in Georgia; falling victim to a fatal mix of lack of information, poor insurance coverage, and low levels of early detection. The statistics are stark - the five year survival rate for women of reproductive age, diagnosed with breast cancer in Georgia, is just 18 percent compared to nearly 60 percent in Eastern Europe - but the response to this information has been tepid.

High profile international assistance organizations and local NGOs have been active, funding free screening and consultation services. But more is needed. Despite an ongoing government outreach program, and the support of First Lady Sandra Roelofs, breast cancer has remained the leading cause of mortality among women in Georgia and the number one cause of death among women of reproductive age (15-49).

HERA Executive Director Marika Davituliani, a forerunner in efforts to educate, screen, and obtain treatment for women, said that the lack of screening and preventive treatment is a major problem. Less than 50 percent of women in the regions are using the free screening available to them, she noted, largely due to a lack of education. The Georgian National Screening Center offers free screening for women. Started in 2006, in Tbilisi, by the mayor's office and the United Nations Fund for Population Activities, the program was expanded nation-wide in 2011.

As with any other disease, early detection and treatment are key steps toward surviving breast cancer. In Georgia, however, more than 68 percent of cases are discovered in the second and third phases of the illness, when treatment is already extremely difficult and expensive. A startling 23.3 percent receive first diagnosis in the final stage of the disease, when there is little chance of survival.

Obstacles to receiving care perpetuate the cycle of late-stage diagnosis, requiring more expensive treatment. This cycle further supports the misconception that breast cancer is a lost cause.

The Race for the Cure, an annual event that started in Georgia in 2009, is using corporate donations to spread the word about free screening and treatment. Davituliani said that the event depends on support from businesses to finance awareness campaigns and help fund screening and treatment in the regions. Simple community education programs and advertising can help save lives, she said, but it requires funding.

A number of well-known Georgian and international businesses support the event and Bank Republic, ProCredit Bank, DLA Piper, Sheraton Metekhi Palace, GeoCell and British Petroleum, as well as others, are helping by incorporating the Race for a Cure into Corporate Social Responsibility strategies.

The trend has picked up speed, with businesses participating in recent races, including Geoplant (Georgian tea brand Gurieli), Beeline, Geocell, M Group, Georgian Baker,, DHL and Sheraton Metekhi Palace.

The Race for the Cure is an easy platform for cooperation between companies and non-government organizations working to improve survival rates. The lack of education about screening, and its role in saving lives, is a major obstacle for reducing the mortality rate.

Megi Papiashvili, a participant of the Race for the Cure since 2009, says that the event helps raise awareness - and support women who are currently battling the disease. During the race, Papiashvili said, women can see first-hand that "there is an exit from this seemingly hopeless situation."

"One of the most vivid examples of comradeship I witnessed was a Georgian woman who had just been diagnosed with breast cancer and was afraid to talk to her family," she recalled. "A breast-cancer survivor at the marathon told her what to do, step-by-step, and encouraged her to use family members as the most important support system during her battle."

Raising awareness, and increasing education, however, is expensive. Davituliani noted that corporate sponsorship for the Race for the Cure event and outreach has decreased over the past two years. Last year HERA was able to raise 50 thousand lari, a decrease from previous years. This year, the NGO has not been able to reach that level.

Without funding, NGOs like HERA are unable to help women who fall through the cracks; women who do not qualify for state insurance, and who either do not have private health insurance, or whose insurance policy does not cover the necessary treatment.

The way insurance companies treat cancer has changed over the past year, noted insurance specialists at Financial Brokers Georgia (FBG).

"In 2010, [insurance companies] didn't have that kind of coverage- it was a known fact that cancer was on the "standard exceptions list" of all insurance companies," explained Margarita Zhiznevskaya, the CEO and Owner of FBG.

Since 2011, however, certain insurance providers have started including screening and other preventative care in some coverage packages.

"Coverage for cancer has already been increased and exceptions for oncologic treatment have been narrowed down to a minimum," noted Shorena Miminoshvili, the medical service manager at FBG.

According to FBG, major insurance companies offer limited co-financing, capped at 2000 lari - a sum that is easily surpassed in most oncologic disease treatments. Higher premiums can result in more extensive coverage, however.

Another option is state insurance that is capped at 15 thousand or 12 thousand lari for invasive and therapeutic treatment respectively. But planned chemotherapy is not covered here either.

Insurance companies are more orientated towards treatment, rather than screening or self education, noted Dr. Lia Umikashvili, the reproductive health/family planning technical expert at John Snow Inc in Tbilisi.

"Maybe some can say that it is the job of public health, of the state and federal government, but I think it will save money for the insurance companies too if they these clients and take care of them from the very beginning," she said.

In addition, an estimated 67 percent of the country's 4.2 million citizens do not have health insurance, according to official statistics. Women who are over the age of 16, but under the age of 40, have a difficult time receiving affordable care, noted Davituliani. Funds raised during the Race for the Cure allow HERA and its clinic to help patients with treatment costs.

"People are often coming who are over 17 because [the state program covers until age of 16]. If we have funding, we can [help pay] for services [that are not covered by the state]," she said, noting that the more care they can provide, the more funding they have to spread awareness to help tackle the fear that is costing women their lives.

"The stigma really lives, lives, lives in everybody," Davituliani said, noting that women refuse to be screened out of fear they will hear they have cancer - a decision that can cost them their lives.

"That is why we [all] need to work with their mindset...that is why we need to break this stigma."