Motherhood Magazine
Welcome to Motherhood - Pakistan's first parenting Magazine

Health Heed

A Myth Unresolved

Breast Cancer in Pakistan- its Causes and Treatment
By: Kalim ur Rehman

An 11-year old girl Minahil, belonging to the village Rosay of district Sheikhupura, Punjab, lost her mother due to breast cancer. She still visits her mother’s grave with the same grimness as she did six years ago, at he time of the passing away of her mother. When BBC’s correspondent, Cherie Blair, visited Pakistan, she interviewed Minahil. In her interview, Minahil expressed her desire of becoming a doctor. However, her father, a poor farmer, was unable to bear her educational expenses. When this interview was broadcasted, a British national approached Minahil and offered to pay for her education. Minahil has now become optimistic about her future as she aspires to serve humankind, and believes that this may help her cope with the sense of loss that she has been suffering since her mother’s death.

Needless to say, the death of a young woman, who did not survive her fight against breast cancer, is not merely a death of an individual, but in fact, it's the first step towards the destruction of a healthy home, a lifelong insecurity for her children and misery for the whole family, in general.

Breast cancer remains highly prevalent in the South Asian region, for reasons unknown. It is the second most common type of cancer, after lung cancer, in Pakistan, and is ranked first in the Pakistani women. There has been a significant increase in the number of breast cancer cases in Pakistan since the 1970s, partly due to the modern lifestyle in the upper class. Data of cancer patients from different major hospitals depicts highest ratio of breast cancer among all other types.

The main cause of breast cancer is still unknown but different factors can become the cause. The risk factors that can trigger the disease are sex, age, childbearing, hormones, a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use and radiation. Hereditary factors play a role too, but research is still on its way to find the cause of breast cancer.

New researches claim efficacy of Vitamin D for reducing cancer rates by well over 70%. A proper and prolonged exposure to sunlight daily is enough to help create Vitamin D in the body. Vitamin D is self-generated by the body, and therefore it is very rare that any external source is needed apart from the daily intake. The problem develops when exposure to sunlight becomes infrequent.

The disease may occur at any age, and is curable if detected and diagnosed in its early stages. Usually patients consult their doctor after the disease reaches its last stage. Lack of medical facilities and awareness, and women’s hesitance to discuss the disease with male members are the main causes for the high number of breast cancer patients in the country. Trained lady health workers can play an important role in making the awareness campaign a success.

Most breast cancer cases in Pakistan are detected at stages III and IV. After these advanced stages, the cancer can reach the bones, neck, lymph nodes, arms, liver and lungs.  According to the Pink Ribbon Campaign, without treatment, 75 percent of breast cancer patients in Pakistan may die within five years while the rest are likely to die within the next five. One out of every nine women in Pakistan faces the risk of the disease. With the average age of occurrence of the disease being 53 in Pakistan, it is recommended that women should begin going for scans starting from age 40, and get a physical examination once every year.

Self-examination or clinical examination can help in finding the lump. But all lumps are not always cancerous. To rule out the danger, different screening methods are used. X-ray mammography, MRI and CT scan can help in localizing the lesion. Various laboratory investigations can help in grading the stage of the breast cancer.  After localizing the lesion and accessing the stage of the disease, surgery is the first line of treatment followed by radiation therapy, chemotherapy, hormone therapy, and immune therapy.  In the last few years, the death rate graph declines due to availability of the most advanced surgical and medical techniques.

The stage of the disease decides the way the treatment will be carried out. Interstitial laser thermotherapy is, nowadays, an innovative method for the treatment of breast cancer with minimal side effects reported so far. It is less invasive and surgery is not required in this method for removing the lump. Moreover, survival of the patient during the intermediate follow up is good. Radiation treatment after surgery can reduce the risk of recurrence when delivered in the correct dose. Patients are, thus, divided into low-risk patients and high-risk patients, and the treatment is done accordingly. During the treatment, the patient’s immune system is highly compromised and hence, immune therapy is required.