October is a special month worldwide, marked by a collective effort to raise awareness about breast cancer, known as Pinktober - to support those who have been diagnosed with, are battling, or are recovering from the disease. This week You! shares some courageous stories of cancer survivors. Read on...
1 in 8 women globally are predicted to be diagnosed with breast cancer during their lifetime and unfortunately, the death rate is disproportionately high in women from low and middle-income countries like Pakistan. While 9 out of 10 women survive in high-income countries over a period of 5 years, this estimate drops to 6 out of 10 in India and 4 out of 10 in South Africa. To bridge this gap, the Global Breast Cancer Initiative by WHO, identifies three main pillars: Create awareness among public and healthcare providers so that we are able to diagnose 60 per cent of invasive breast cancers at stages I and II; Complete diagnostic imaging and tests within 60 days; Provide access to treatment in a way that 80 per cent of patients have access to multimodality treatment without abandonment. All these are measurable goals that aim to address inequities and close the care gap for women battling breast cancer, regardless of where they live. This week You! shares some courageous stories of cancer survivors. Read on...
Gulnaz Ayaz was 28 years old when she felt a lump in her left breast. “There was no one in my family who had cancer and the word did not even cross my mind at that time. I discussed the lump with my mother who said it could be due to breast-feeding my daughter. My daughter was around two years old at that time. I waited for a month, hoping for the lump to go away, but with each passing day, I felt that something was not right. I went to a gynaecologist who told me to get ultrasound done. After the ultrasound, I went to three different hospitals and everyone told me there was nothing to worry. The lump was not going away and I knew this was not normal. Then I discussed with my father about going to Shaukat Khanum Hospital, which meant facing the possibility of ‘cancer.’ It turned out to be a life-saving decision. I was told that only a biopsy could confirm if it’s cancer. I went to a surgeon who surgically removed the lump and sent the sample to a private lab. When I collected the report, I remember reading the diagnosis as ‘invasive ductal carcinoma’. I had to look it up to know it meant cancer. I spoke to my friend who is a doctor in the US, and she told me that it seemed to be an aggressive type of breast cancer but she said ‘Gulnaz, you have to fight it’,” narrated Gulnaz.
It was around January of 2014 when Gulnaz formally registered as a patient at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Lahore. Her treatment plan included six cycles of chemotherapy and twenty-one sessions of radiation therapy. “I had long hair and I asked my oncologist if he could mix something in the medicines that would save my hair. I still remember what he said, ‘your hair will grow back but this is about your life and this treatment is crucial to save your life.’ Then after my third chemo, I wanted to give up because I felt very exhausted physically, and emotionally. I asked my doctor if I could stop treatment. When I was on the verge of giving up, he motivated me to keep going and said ‘you are already half way through, don’t give up now.’ It was because of his encouragement and because I kept thinking of my daughter that I continued. I was struggling with my married life at that time because my in-laws were not supportive during treatment and my husband divorced me during radiation therapy. I survived through it all. My active treatment ended in 2015 and then I started studying for a Master’s degree. After graduating, I started teaching at the same private university. My five-year follow-up has also taken place now. My message for other women is that do not ignore any unusual symptoms and go to the right place for diagnosis and treatment,” elucidated Gulnaz.
Gulnaz stood up for herself despite multiple challenges and survived breast cancer. Her story highlights the challenges women face even in urban settings in dealing with a breast cancer diagnosis; from psychological battles to navigating the healthcare system.
“I am a mother of three children. My oldest is in college, the middle one is in class 10 and the youngest is in class 6. I am a home-maker and my husband is a laboratory technician,” said Nabila Robin from Gujranwala. “In 2022, I noticed a lump and visited a gynaecologist who suspected something was wrong. We went to a local hospital where we were advised to go for mammography and biopsy urgently. My husband read the test results from the biopsy report which revealed the diagnosis of breast cancer, fortunately in the initial stage. Both of us cried a lot at that time. There was also a sense of confusion about what to do next. In our city, a hospital offered chemotherapy but they said they wouldn’t treat any complications and did not offer radiation therapy or surgery. Then, an oncologist told me that my cancer was treatable but we had to go to Lahore in order to be treated at SKMCH&RC. My treatment plan included chemotherapy, surgery and then radiation therapy. I have completed active treatment and I am on follow-up now,” told Nabila.
“I am grateful to the referring doctor for guiding me properly and then to my husband and children who were extremely supportive and stood by me throughout this difficult time. My son said to his father, ‘I know about cancer Papa, please don’t worry about us and take mama to the hospital.” And my older son told me, ‘you are brave. Fight this disease mama.’ That day, I felt I would survive,” expressed Nabila.
Saima from Lahore is a mother of three children and is undergoing treatment for breast cancer at a large tertiary care cancer hospital. She felt a lump while taking a shower in April 2023. As soon as she could, she visited a surgeon. “My father also suffered from cancer and I was aware of the importance of early detection of cancer. I did not waste time by going to different clinics and I knew that a lump meant a visit to a surgeon. He performed biopsy and referred me to Shaukat Khanum Hospital. The doctor there explained the treatment plan, which included chemotherapy to shrink the tumour, followed by lumpectomy,” shared Saima. “Please look after yourself and take out some time for breast self-examination once a month. Moreover, go to a qualified doctor instead of wasting time with un-related and unqualified practitioners,” urged Saima.
Dr Sadia Abdullah, Consultant Radiation Oncologist, endorsed Saima. “Take out 5 minutes for yourself and regularly perform breast self-examination. Watch out for lumps, changes in size, shape, skin, nipple discharge, even lumps in the armpit area, and tenderness that is persistent. Don’t be shy about it, talk to family members and seek medical attention. The condition may be benign or cancerous but it is important to get it checked to rule out cancer,” she stressed.
Dr Anum Nabeel, Consultant Gynaecologist, working at the District Headquarter Hospital in Sheikhupura, shared insights based on her experience with breast cancer patients from rural areas. “In rural areas women face some additional layers of challenges. Women in rural population often do not understand the gravity of cancer and possible consequences of ignoring breast cancer symptoms. They leave it and hope it will go away on its own. Another problem is that they rely on their male family members to take them to a healthcare facility,” shared Dr Anum.
The DHQ where she works has ultrasound and mammography facilities where patients come for diagnostic radiology tests from smaller healthcare facilities, but for final diagnosis via histopathology of tissue sample, patients have to go to private labs or hospitals in the cities. This is out of pocket expense for women and many end up not following through with it. Sometimes pregnant women reach her with visible signs of breast tissue damage but since they cannot afford expensive tests they go for a more affordable option, which is hakeems or herbal medicine practitioners.
Dr Zeeshan Tariq, Consultant Medical Oncologist at SKMCH&RC, Lahore, compared his experience of working with breast cancer patients in the USA and in Pakistan. He said that social taboo still affects early detection in our country. “Women don’t discuss this topic with anyone or when they discuss, they are not taken seriously, or at times instead of going to a doctor, they are taken to a hakeem. In rural areas, the sophisticated investigation tools for breast cancer barely exist. “Early detection is important and women can achieve this with regular breast self-examination for women under 40 years of age and mammography for women above 40. In stages 1 and 2, survival rates are over 90 per cent,” he informed.
Discussing treatment options, Dr Zeeshan said, “If detected early, for example stage I, then lumpectomy with radiation is an option, which means that complete removal of breast is not necessary. As the stage progresses, chemo is needed along with radiation and surgery. In late stage, surgery is often not useful and treatment includes chemo and palliative radiation. Breast cancer is not just one type of cancer. There are different types and treatment options may vary depending on the type of breast cancer. For example, HER-2 positive breast cancer responds to targeted therapy and triple-negative type of breast cancer responds to immunotherapy.”
“However, these are very expensive drugs and the decision to utilise cost-prohibitive drugs has to be made carefully. The good news is that these are available free of charge to needy patients at SKMCH&RC - certified by the Quality Oncology Practice Initiative (QOPI), which means international standards of cancer management are met,” he added.
“Early detection is the key to saving lives. You should not hesitant to seek medical attention if you feel or see any unusual symptoms; and go to a relevant and qualified doctor; at least get an ultrasound done, and follow it with biopsy, if indicated,” he advised.
According to Dr Amina Khan, consultant surgical oncologist from Shaukat Khanum Hospital, improved surgical techniques now mean that mastectomy is not the only option. We offer breast saving options to our patients. “When I started training more than 20 years ago, mastectomy was the main type of surgery being performed but not anymore. She said that, on average, she manages 1,500 breast cancer procedures in a year and lumpectomy to mastectomy ratio is 70:30, which means that majority of the patients undergo breast-saving lumpectomy which is equally effective and saves patients from psychological trauma. Even with mastectomy, we offer breast re-construction to patients. “Women are afraid of treatment because of side-effects but we are able to control side-effects better now. Breast cancer is manageable and you can live a meaningful life after treatment,” assured Dr Amina.
The writer is a LUMS alumna and a community social worker with special interest in public health, philosophy, and human rights. She can be reached at mariamk27@hotmail.com. Her X (formerly Twitter) handle is @mariamibkhan
