Pink battle
A COMPARATIVE analysis of breast cancer data from over a decade ago to now shows interesting figures: the average age of diagnosis has shifted in women from the sixth to the fourth and third decades of their lives. Today, even young girls are falling prey to the disease, making the situation increasingly complex for countries like Pakistan where breast cancer occurs more often in comparison to other Asian countries.
The total number of breast cancer cases diagnosed in 2020 in Pakistan was 25,928, according to GLOBOCAN 2020. This accounts for 14.5 per cent of new cases detected in the country throughout the year. The infamous ‘one in every nine women’ ratio of Pakistani women becoming afflicted with breast cancer is at once frightening and alarming. Pakistan, sadly, also has the highest mortality rate among Asian countries.
Meanwhile, a study conducted by Zunaira Shoukat and other researchers indicated that a staggering 63.2pc of its participants lacked knowledge about breast cancer and 64.7pc were ignorant about mammography screening. For a country with such a high incidence count, these figures are shocking and point to the need for greater awareness and information about the disease. It was also noted that the lack of knowledge is not due to poor education alone as many educated patients of a higher socioeconomic status displayed negligible understanding about the malady, and more so about the means and importance of reporting it in time.
The reasons for Pakistan’s soaring cases and ways to reduce occurrences have been under discussion for a while.
Each year over 83,000 cases of breast cancer are reported in Pakistan.
Non-modifiable risk factors for breast cancer include aging, genetic mutations, family history, etc. Modifiable risk factors are sedentary lifestyles, hormone therapies and certain habits such as smoking. What is more important is that many women, especially in Pakistan, become breast cancer patients without any risk factors, whereas, a risk factor does not necessarily translate into becoming a victim of the ailment. So the next best option is screening, early detection and minimising risks. Treatment is possible when it is diagnosed at an early stage because timely treatment is neither complex nor expensive. Early detection is one of the most pressing concerns worldwide and is achievable with public education and awareness.
Estimates show that each year over 83,000 cases are reported in Pakistan and most cases of breast cancer in Pakistani women are diagnosed at an advanced stage. Apart from a low literacy rate among women, ignorance about symptoms and inhibitions around breast cancer form major reasons for late diagnoses.
One would like to believe that due to initiatives by the government and NGOs, an adult woman unaware of the affliction and its impact is a rare sighting. But, rural areas and a thorough research of facts and figures reveal sad truths.
The American Cancer Society says that women between 40 and 44 years should be given the choice to go for annual breast cancer screening with mammograms while those from 45 to 54 years should be advised to get mammograms done every year. Unfortunately, mammography is only available to a particular segment of society that can afford the facility.
Screening facilities in government hospitals are severely overstretched and rural areas are deprived of primary healthcare, so expecting a specialised screening service is wishful thinking. The PC-1 of a project to establish screening units in seven hospitals across KP in collaboration with the Institute of Radiotherapy and Nuclear Medicine was approved last year to ensure the ‘availability of world class screening facilities free of cost’ to the masses. The project faced red tape issues and has been delayed; once functional, it will go a long way towards ensuring the well-being of the people of KP. Another noteworthy project is the recently inaugurated KHAS hospital in Shikarpur in interior Sindh.
A relatively newer standard of care in the management of breast cancer is genetic testing. The BRCA-1 and BRCA-2 gene mutations are the strongest risk factors for breast and ovarian cancers to date. Unfortunately, despite its benefits, the tests have many barriers, especially in lower-middle-income countries — limited access to genetic counselling, affordability issues and complicated testing criteria.
While the efforts of the government and NGOs to spread awareness through communication media are commendable, future health policy frameworks require tangible features, such as more screening centres in remote areas and subsidised BRCA mutation testing for a subset of eligible patients, because we cannot forget that the annual burden of the disease is 12.5pc of new cancer cases.
The writer is an academic medical researcher and doctor working for a tertiary care hospital in Karachi.
Published in Dawn, October 19th, 2023