In the month of October, the breast cancer awareness month, we are celebrating stories of courage with some brave breast cancer survivors and finding strength in their journeys of hope…
Each breast cancer patient has a different story, making her cancer journey unique. A common thread weaving through these stories is often women ignoring red flags about their health. In many cases, their priority is given to families, children, husbands, work, and everything else except themselves. There is a need to shift our mind-sets, where we acknowledge that our health is important at all times. Paying attention to our health should not only be when something feels terribly wrong and requires curative therapy but an active effort for prevention should be acknowledged as a critical part of healthcare.
The latest available Global Cancer Observatory Report estimates 25,928 new cases of breast cancer in Pakistan during 2020 and 13,725 deaths. In the absence of a functional national cancer registry, although the actual figures may be different from these estimates, we know that behind each number is a woman and we must work together to save these lives with early detection and by providing access to treatment.
One of the earliest examples of breast cancer awareness in Pakistan can be found from 1998, a photo published in The News, depicting a walk organised by Shaukat Khanum Hospital from Bagh-e-Jinnah to the Governor House in Lahore. The walk was led by former Lahore High Court Judge, Justice Nasira Javed Iqbal and a large number of people participated in the event to show their support for the cause.
Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) opened in 1994 as the first dedicated cancer centre in Pakistan where quite early on, it was noticed that women were presenting late for treatment of breast cancer because of stigma and lack of awareness. Efforts began thereafter to address the issue, with hope to be able to save lives via early detection. Commenting on breast cancer awareness, Dr Aasim Yusuf, Chief Medical Officer of the memorial trust shares, “Pakistan has one of the highest incidences of breast cancer in Asia. Early detection is the best means of optimising survival in those diagnosed with breast cancer, but unfortunately, lack of awareness about breast cancer in Pakistan often results in this treatable disease being detected at a late stage, when cure rates are much lower. Although, we have noticed some improvement over the years regarding earlier presentation of patients, many women continue to lose their lives due to delays in diagnosis and because of inability to access quality treatment. Our commitment to raising awareness on this subject has remained unwavering – in addition to digital media campaigns, we also engage national electronic and print media to maximise the impact of our message.”
In early stages, women with breast cancer may not have any symptom, which makes breast cancer screening important. Cancer screening involves testing apparently healthy people for detecting signs of cancer development. Understandably, in low- and middle-income countries like Pakistan, it is difficult to offer screening to the entire eligible female population free of charge. Therefore, in addition to raising awareness about mammography for women who are above 40 years, campaign messages promote breast self-exam for women between the ages of 20 and 40 years, which does not require any resources except for a woman’s will to take care of her health.
On closing the care gap for patients in Southern Pakistan, Dr Aasim Yusuf says, “All cancer patients deserve an equal opportunity to fight cancer, with dignity and access to the best possible treatment, regardless of their socio-economic or geographical background. In 2010, we started providing cancer screening and chemotherapy services at our Karachi Diagnostic Centre and Clinic. We have now undertaken the gargantuan task of building Pakistan’s biggest specialist cancer hospital in Karachi, where cancer care will be available under one roof, for all patients, irrespective of their ability to pay. This will be a source of huge relief for cancer patients from Sindh and Southern Baluchistan, who will soon have access to curative and palliative therapy near their loved ones, and where we expect to continue our tradition of providing completely free treatment for cancer to over 75 per cent of all patients seen.”
Such organisations have worked consistently over the years to create awareness on breast cancer. In recent years, Pakistan’s First Lady, Begum Samina Alvi was seen personally championing the cause by actively participating in and organising awareness sessions and starting initiatives such as replacing ring tones on phones with breast cancer awareness messages with the aim to reach women population not only in the cities but also in villages and remote areas of Pakistan. In the month of October, the breast cancer awareness month, You! is celebrating stories of courage with brave breast cancer survivors Gulnaz, Sadia, Saba, Zainab and Andaleeb, and find strength in their journeys of hope.
The struggles and victories of these women from different areas of Pakistan reveal that despite several challenges of battling cancer in a low-resource setting, our women and our health systems demonstrate great resilience.
A challenging journey
“I am a teacher by profession. I live in Orangi Town, Karachi. My husband owns a grocery shop. In 2019 I was diagnosed with breast cancer. I was devastated and worried at the same time as we could not bear the cost of cancer treatment. To my relief, after an interview, I was accepted for financially supported treatment by SKMCH&RC. My treatment started with chemotherapy at the Karachi Diagnostic Centre and Clinic in August of 2020. I had to visit different healthcare facilities for surgery, radiation therapy and chemotherapy. My journey was challenging not only because of the disease I was fighting but also because of lack of coordinated healthcare services available to me. Now, I have completed active cancer treatment and returned to teaching. If I am alive today, it is because of this hospital, my mother, my husband - and all those who remained a source of strength for me throughout my cancer journey,” shares Gulnaz, a cancer survivor in Karachi.
“I am from Multan and I have two daughters and a son. Both my girls go to school, and my youngest son is nearly four years old. I am a house-wife and spend my days taking care of my family. When I first felt symptoms suggestive of breast cancer, I tried to find treatment in my own city, Multan. However, the doctors there advised surgery right away and I was not satisfied with that suggestion. Some of my relatives had received treatment at SKT and advised me to visit there at least once. I knew my children needed me and seeing them motivated me to stay strong. When I felt disappointed and felt like giving up, I turned towards God and knew He must have planned what is best for me. Then I will find the strength within to continue the struggle,” states Sadia.
“My message for other women is that you must get past any shyness, hesitation or fear when seeking treatment. You must prepare yourself to overcome challenges such as travelling, leaving behind children so you can fight this disease and trust me, you will get past this difficult time and will return to a normal life just like I did,” stresses Sadia, a cancer survivor from Multan.
“When I noticed a painful lump in my breast, my mother became very worried. She insisted I go to a doctor so we went to a local hospital in my hometown, Narowal, and we were told there is nothing to worry. They even performed surgery and found a mass but no one told me anything about cancer. After about six months, my son was born and when he was around two months old, I felt a lump once again. I was visiting my brother in Lahore where I had some diagnostic tests at a hospital and the doctors advised me to visit a bigger hospital.
I did not know much about cancer except that it could be a very dangerous disease, even fatal. I still remember the day when my parents brought me to the hospital. It was a cold rainy day and their tears mingled with rain drops as they wept at the ominous journey that awaited their daughter. I was asked to pray that my cancer was at a treatable stage. I was most upset about the fact that my youngest son was only two months old and I could not imagine how he would fare without his mother. But here I am now.
For other patients, I would like to say that indeed it is difficult to hear the word ‘cancer’ in the same sentence as your own name and the world seems to crash around you; some have young children while others are children themselves, but don’t hesitate and visit a dedicated cancer hospital to seek treatment in a timely manner,” elucidates Saba, a cancer patient from Narowal.
“I was diagnosed with breast cancer at a very young age when I did not even fall in the recommended age for screening mammograms. After diagnosis, treatment is the next step. For me, coming to terms with my diagnosis was a very difficult task. The doctor at a local hospital told me that I must begin chemotherapy immediately otherwise, if I collapse, it would not be their responsibility. That day, I was hit with the realisation that I am dealing with something very scary and everything around me felt uncertain. My son was quite young at that time and remained unaware of the way his mother’s world had suddenly turned upside down. I did not want to worry him so I made special effort to act strong for him and this became a source of courage for me. I am well today and teaching at a university,” narrates Zainab.
“To others recently diagnosed with breast cancer, I would say that everyone reacts differently to a cancer diagnosis; some become angry, others go into denial. Regardless of how you feel, you must not delay treatment. Find your source of strength and begin the battle,” adds Zainab, a breast cancer survivor from Lahore.
“My medical history included shoulder injury from Army Public School terrorist attack. I lost my son that day and I cannot explain how traumatic that time was for me. Two years later, in 2016, I noticed a change in my breast and fortunately, I was aware that this was not normal. I went to a walk-in clinic in Peshawar. When I was diagnosed with cancer, I thought that perhaps I had survived the terrorist attack earlier because God had another test for me. I was determined to give my best to soldier through this test. During this journey, I drew strength from my faith and also, from other breast cancer survivors. I am a teacher and I would think of mothers whom I had met in parent-teacher meetings - who were cancer survivors. Stories of these survivors gave me hope,” comments Andaleeb.
“Today, I have completed cancer treatment and resumed teaching. I have two children now and I try to cherish every moment with my family. In my message for other women going through breast cancer, I would like to say that there are many highs and lows in life; this too shall pass and remember, live every moment of your life to the full,” advises Andaleeb, a breast cancer survivor from Peshawar.
The writer is a LUMS alumna and a community social worker with special interest in public health, philosophy, and human rights.
