“Lebanese women get breast cancer ten years
earlier than women in Western countries.”
It was a statement to make me sit up in astonishment. I was sitting in my
doctor’s office, having come to see him for my annual check-up.
Dr. Honeydew (no, of course not) sat behind his desk in a spotless blue shirt
and red tie. He had asked me if I would like to have a mammogram and I was bemused by the question, having expected that he would tell me
if I needed one this year. Mammograms aren’t a barrel of laughs, as you may or
may not know. Why would I go to all the trouble of making an appointment and
driving to the hospital if didn’t need to? I could give my boobs the equivalent
experience by going home and asking M to back the car over them.
“I had one done last year,” I said. “Do you think I need another one this
year?”
That’s when he told me about the cancer rates here. “The average age of breast
cancer patients here in Lebanon is ten years younger than in places like
Canada. That is why I recommend an annual mammogram for my patients over forty
years of age, but because you are Canadian I will recommend that you have one
every two years until you are fifty.”
“But those rates don’t make any sense,” I said. “What about the healthy diet
here, the low rate of obesity?”
“Ah, but Lebanese women smoke a lot,” he said. “In Canada people are ashamed to
smoke. They try to stop. Here, they are proud to do it.”
Since he said it wasn’t necessary I opted to skip the dough press until next
year, but a part of me was thinking that breast cancer rates in Western
countries are presumably based on environment and lifestyle, not genetics, and
since I was living in Lebanon wouldn’t that make me prone to the Lebanese
cancer rates?
Dr. Honeydew’s words kept coming back to me in the days following my check-up.
I didn’t exactly doubt them, but I did suspect them of being an exaggeration.
Finally I had a look on the internet for confirmation and guess what? It’s
true. Dr. Honeydew did not exaggerate.
I learned that the median age of breast cancer patients in Lebanon is 52 years,
compared to 63 years for developed countries such as the US.
Unfortunately, other than one or two cautiously speculative observations about
the high incidence of smoking in Lebanon, none of the researchers had submitted
any theories as to why the breast cancer rate is so high here.
If I were to be instantly and magically endowed with a PhD in the relevant
branch of medical research I’d get right to the bottom of this and the first
place I’d start looking would be air pollution. If I haven’t said it before,
the pollution is terrible here in Beirut. In the three years since we’ve
been back living here it has, for me, grown to eclipse all other negative
aspects about this city. Driving
down the road is dangerous here; worse are the prospects of a pedestrian. Sitting
at home in front of your tv can be dangerous, on certain lively nights. But the
most dangerous thing you might do in Beirut is breathe.
Here are four non-scientific facts from my personal encounters with air
pollution in Beirut:
1. The smell of diesel and car exhaust is strong enough where we live to force
me to keep the windows closed most of the time. I air out the apartment in the
morning and when that’s done I close the windows tight again.
2. The pollution leaves a sooty black film on anything left outside. I notice
it most on our balcony. If I clean the balcony floor one day (with soap, hose
and mop; so that you could eat off of it if you wished), the next day it will
be dirty. If, when I’m hanging up laundry to dry, the sleeve of a white shirt
brushes the floor of the balcony it will have a sooty-black smudge.
3. Depending on how windy the day is, my line-dried laundry usually smells
strongly of exhaust. I’ve taken to putting much of my washing in the dryer to
avoid this.
4. Last week when I washed the inside of my kitchen window I used a soapy
sponge and a squeegee. As the water ran down over the white aluminum frame at
the bottom of the window I saw that it was dark grey (and I washed this
window about three months ago).
You can find scientific papers discussing air pollution in Beirut on the
internet but they’re long and confusing and often out of date. They all seem to
conclude with weak, and, I have to say, stupid summaries in which they take a
very long time to cautiously opine that the air is really quite polluted here
and more of us ought to use bicycles (have these people ever tried to cycle
around Beirut streets? You’d live longer if you took up Highland dancing in a
Cambodian minefield).
I don’t know why the authors of scientific papers are so afraid of speaking in
plain English but I have waded through the sludge and selflessly – some might
go so far as to say heroically -- plucked out one clear fact for you:
particulate matter concentration fifteen years ago averaged 200 micrograms per
cubic metre across Beirut. Currently it may run as high as 500 in the worst areas of the
city. Compare that to the U.S. Environmental Protection Agency limit of
12 as set out in their National Ambient Air Quality Standards.
That’s a frightening difference even if you don’t have any idea what
particulate pollutants are or how they hurt us. You probably know what happens
to people who inhale asbestos dust; well, this is the same concept. I’ve read
only a little about particulate matter but I do sincerely advise you to avoid
pursuing knowledge in this area. Frankly, it’s terrifying. These are microscopic
bits of solid or liquid matter suspended in the air and when we breathe them in
they sail right past our nose hairs, through the sinuses and down into our
lungs. They’re just so very small that our normal defences can’t catch them. If
they’re small enough they may even pass through our lungs into our bloodstream.
Once in the bloodstream they can reach any organ in the body. In addition to
lung cancer and all manner of respiratory illnesses they harden arteries and
stop hearts. Really tiny particles may even reach the brain and imbed
themselves there, snuffing out precious circuits and mimicking Alzheimer’s
disease.
An increase in concentration of 10 mcg/m3 particulates in the air is
associated with an increase of 1% in mortality rate. I don’t know if that
relationship is a straight slope into which you can plug any figures, but if it
is that means increased mortality here in Beirut is twenty to fifty percent
higher than it would be if the air was clean.
This is really, really bad. I won’t depress you further with information about
other air-borne pollutants (particulates aren’t the only bad things in the air)
or chronic bronchitis rates in this country. Rather, I will leave you with the
image of Dr. Honeydew stepping ahead of me out of his office after the
check-up and, going a few metres down the hall, holding a door open
expectantly for me.
The thing was, the door he held wasn’t the exit door. It wasn’t even in the
direction of the exit door. Since we had definitely concluded our visit I
didn’t understand what was happening.
I stopped and looked from him to the door he held open and back up the opposite
direction of the hall where I knew the real exit door to be.
“Is this – what--?”
“It’s the bathroom,” he said, and gestured for me to go inside.
Well, it was uncanny. The hot chocolate I had drunk in Caribou before my
appointment had filtered through and I really needed the toilet but how could
Dr. Honeydew possibly know that?
As I blinked in surprise and stepped past him into the bathroom, he smiled. “I
saw during the ultrasound exam that your bladder was full.”
Honeydew, I thought, you know too much.