In an exclusive interview with You! Dr Rufina talks about her career and women’s health…
Hailing from Shikarpur, Dr Rufina Soomro is a renowned name in breast diseases and surgery. She is the Head of General Surgery Department at Liaquat National Hospital in Karachi. She did her F.C.P.S. in November 1991 and went for her breast surgery training in Ireland. Upon her return, she started her breast cancer clinic in January 1994, which is now one of the busiest clinics in the country. She has since been working as a consultant and breast surgeon. In an exclusive interview with You! Dr Rufina talks about her career and women’s health…
What encouraged you to pursue medicine?
It was my childhood dream. My grandparents also encouraged me to pursue medicine. I just assumed I’d do medicine and open up a clinic in my hometown of Shikarpur. But during my house job, my peers and supervisors pointed out that my surgical hand is good. The appreciation persuaded me to take up surgery. I took up breast surgery specifically because I saw that women were hesitant going to male doctors so, I went to Dublin, Ireland, to get my training.
Do you think we have enough awareness relating to breast diseases?
It’s better than when I started my career. Back then, even using the word ‘breast’ was considered a taboo. Earlier in my career, I made many videos but they were never played on television as the Islamabad Censor board did not consider it ‘socially-acceptable’. Now, during Pinktober, you’ll find many survivors sharing their stories. We even have a phone message about breast cancer, which shows improvement but we have a long way to go. I will probably see positive results when men are also onboard about women’s health. Many women are not able to take their own decisions without the men in their lives, whether the reasons are financial, emotional or moral. Our jobs should not only be about informing the women but to take men onboard too; because I’ve seen in cases where men and women are on the same page, the outcome is different.
You mentioned a censorship issue, how can we work around that?
When I go for awareness sessions, I cannot and do not show real images or videos because it is not going to be acceptable. I have made pencil sketches for breast examination which can be used. The real videos can be shown in a small, closed group of women to help them explain.
What is the hardest part of your job?
Breaking the bad news. In Pakistan, sometimes we have to break the news to the family first, compose them, and then break the news to the patient. Even though this is not the norm. You have to have the right choice of words (not just outrightly blurt out the news) so the patient is receptive. We try to give them a realistic picture in the best way.
Do patients ever get aggressive when you break the news?
It’s not anger. Most of them cry and get upset. They may feel mistrust or go in denial. They would ask to repeat the biopsy. But mainly their first instinct to is cry, it is very rare to see someone get aggressive.
What kind of impact does the diagnosis have on the patient’s mental health?
Nobody wants to hear the word ‘cancer’, so you have to be sensitive to the patient’s feelings. You have to give them facts but be kind to them. They would be in shock so you have to give them space. A young girl came to me crying who had a simple benign lump. She had assumed that her breast will be cut off because she spoke to 2-3 patients in the waiting area who had theirs’ removed. She got so afraid that she didn’t want come inside for the check-up. I told her she didn’t have breast cancer, so she wouldn’t have to get it removed. She literally hugged me.
You have to be kind to your patients. Those who lose hope, those who are depressed or those who do not go with a positive attitude, they tend to have an adverse outcome. Rarely, if I feel there is a need, I consult a psychiatrist or psychologist.
How important are support groups?
Very important. No matter how experienced I am, I cannot convey the same message that one breast cancer survivor can to another. Sometimes I am not able to convince a patient for a particular treatment, but another survivor can do that.
In the basement of this hospital, we have an oncology support centre, which is run by breast cancer survivors, and one of them is a beautician. Now she is a part of the staff here. She helps patients going through chemo cut their hair, make wigs for them. We even provide stencils for eyebrows. She teaches them how to do facials, nail and hair care. They sit down, they talk and share their journeys. We have a beautician, a journalist and a nurse who are survivors, they come there on a daily basis and volunteer. So, anyone going through fear or anxiety goes there. This support centre provides a kind of therapy.
When is the right time to start breast screening?
Girls should be taught breast examination soon after puberty (15 onwards). A couple of months ago, an 18-year-old year old was diagnosed with breast cancer, so it’s best to start early. An examination can be done by trained person – can be a general physician, gynaecologist or a midwife. Moreover, we ask for ultrasounds for women under 35 and mammograms for women over 35. Women with a family history of breast cancer should get a mammogram after every 5 years; women over 40 should get a mammogram done every two years and women over 50 should get it done yearly.
Is there value in having ultrasound in addition to a mammogram particularly for women with dense breasts?
Yes, there is definitely. Ultrasound and mammogram complement each other and those who have dense breasts, the breast appears white on an X-ray and the tumour also appears white, so it’s white against a white background. That is the reason we ask younger women for an ultrasound. Moreover, the cyst fluid is not visualised in a mammogram. Screening test is mammogram and if it requires any further investigations, then an ultrasound is done.
Are there any other preventive measures for breast cancer?
Apart from early detection, one has to be mindful of any external hormone replacement therapy. It’s to provide relief for women going through troublesome menopause and hot flashes. This treatment is prescribed for a few years (maybe two to five), but I have seen women taking it like multivitamin and they continue taking it until they are 65-70. You don’t have to do that and the same goes for oral contraceptives. Taking them for many years is a risk factor, but if you take a break, the risk decreases. Hormonal therapy should always be taken under proper guidance of your physicians. Control your weight by having healthy foods like adding bowls of salad and fruits in your diet. This is a recipe of preventing everything.
What is the BRCA gene and why should women look out for it?
Those who have a family history of breast cancer or ovarian cancer, the possibility of familial genetic predisposition is high. The BRCA genes are the specific genes and have two types: BRCA1 and BRCA2, which are found in less than 10 per cent of the patients. Those who have it, they have a high probability of developing cancer. As you get older the risk also increases. And the treatments are different depending on a person’s biology. Those who are BRCA positive, we ask them to have prophylactic mastectomy, and later, around at the age of 35-40, we ask to remove the ovaries removed because it has own problems. Angelina Jolie went under a prophylactic breast removal because she was BRCA positive. At the time, it was not easily available in Pakistan but it is now.
Can men develop breast cancer?
Among thousands of women, we do get one male breast cancer patient. With their gender, men do not exhibit the disease but they can definitely develop it if their mother has BRCA positivity. It’s also possible that the man has BRCA positivity and doesn’t exhibit the disease, but it is passed on to his offspring. There is no screening for men, so when they find a lump there, they are already feeling a lot of anxiousness about something being wrong. Men who develop breast cancer undergo pretty much the same treatments.
What are some common myths and taboos attached to breast cancer?
Early menses and late menopause, first childbirth after the age of 35, or not having kids, these are risk factors. However, this doesn’t mean those who have 10 children are safe from it. Risk factors may not be applicable to the entire world, but there are many myths. I could come up with at least 29. One of the common one being that if you’re young, you cannot get breast cancer. Putting on talcum powders, deodorants, sprays, undergarments, wired undergarments these are all the myths. The biggest one is when people say that biopsy will spread the cancer, which is ridiculous since you cannot treat breast cancer without a proven diagnosis. I’d have patients tell me to not do a biopsy because it uses a blade but will agree to for a removal surgery which also uses a blade.
Women in Pakistan find it hard to give time to their health, let alone recreation. How important is this for women?
I agree, 100 per cent! Women in Pakistan care for their children, husband and family, and neglect their own health. They keep ignoring their problems and lingering on the symptoms. Even if they pick up something that’s off about their breasts, they will put if off since it is painless. This becomes a bigger problem later on. A patient of mine was diagnosed with breast cancer six months ago but didn’t come for treatment until now because her mother-in-law wasn’t well. And the whole family knew, by the way. I always stress that a women must keep her health on priority. And, I also tell the men and the family of the patient to focus on the health of the women. They must shift their priorities.
Most women equate house chores with exercise and workout. What is your thought on that?
That does happen, but house chores will not suffice for exercise or a workout. For regular exercise, you should have control of your heartrate and pace. The exercise is to challenge your heart. Even for a walk to count as an exercise, you need to do a brisk one for a particular time. For instance, I might be walking from one corner of this huge hospital to another that will not count as my exercise. I may be burning a few calories but will not substitute as a workout.
To reiterate, your diet and exercise needs to be a priority. As far as breast cancer is concerned, weight gain after menopause is also a risk factor. So, keeping your weight under control is a preventive factor.
What’s the most rewarding aspect of your job?
You have patients come in with fears and anxiety but after treatment, when they feel better and begin to carry on with their life, it feels rewarding. Sometimes patients, even diagnosed with breast cancer, come back to visit to say thank you or pray for you, it feels really good. Similarly, in terms of teaching and training, seeing your students doing a good job and make a name for themselves is rewarding.
How do you maintain a work-life balance?
The timings are in your hand. If you are pushed for time, you can plan your week ahead. If you do this continuously, you build up a stamina to keep up with things at work and home.
What does a typical day look like for you?
I’m off for work every day around 8 a.m. to 4-5 p.m. I have evening clinics on three days and on those days, I work till 8.30-9 p.m. When I come home, I spend time with my family, catch up with my nieces and nephews. Once I am done, I usually have a lot of paperwork to do. After 10 p.m. I read something, reply to emails, academic issues, go through dissertations or finish any other articles pending. Days that I come home early, I usually do groceries, personal work or visit people for celebrations, condolences or to catch-up.
How do you unwind?
It’s very important for me to give some time to myself. I spend time with family and friends. I am lucky to have many good friends in the neighbourhood so I drop in there sometimes, or they would come by. Before Covid, we would travel abroad but now we visit interior or northern areas sometimes.
In your opinion, what are some of the challenges being faced by Pakistani women today?
Women are still not independent in a lot of ways, whether it’s financially or in decision-making. I’m not saying that consulting your family is wrong, but you should start taking some responsibility for your decisions.
What advice would you give to other women struggling to follow their own ambitions?
When women enter their professions, they are enthusiastic and full of ideas, but often succumb to family pressures to leave. I think when you have worked hard and spent so much time and money on it, it’s your moral obligation to serve the society. No matter what the profession, if you have the skill you should contribute your potential back to your society, share it and let people benefit from it.
