Pakistan has highest rate of breast cancer in Asia

LAHORE:Pakistan has the highest rate of breast cancer amongst all Asian countries. According to reported statistics of incidences of breast cancer, one in every nine Pakistani women develops breast cancer at some stage of her life.

“An estimated 83,000 cases of breast cancer are being annually reported in Pakistan and more than 40,000 of those women die every year, which makes it a leading cause of cancer death among women in the country,” said Dr Muhammad Asad Parvaiz, Consultant Oncoplastic Breast Surgeon at Shaukat Khanum Memorial Cancer Hospital, Lahore, while talking in connection with Pinktober – Pink ribbon campaign to observe October as the month of awareness regarding breast cancer.

Dr Asad Parvaiz said that awareness campaign was an effort to raise understanding about this disease and reduce the social stigma of breast cancer through education on signs, symptoms and treatment. Every single patient in our country deserves the best treatment for this potentially curable disease and this is only possible when people know about it and they feel free to talk to their families/friends and doctors. He informed that breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through the breast to the lymph nodes or to other parts of the body.

Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). It may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.

Regarding causes of breast cancer, Dr Asad Pervaiz said, “We do not know the exact cause, but researchers have identified hormonal, lifestyle and environmental factors that may increase the risk of breast cancer. Some important risk factors include immediate family history, old age, obesity, smoking, alcohol, sedentary life style, no pregnancy, not breastfeeding, late age at first child’s birth, early menarche, late menopause and hormone pills (contraceptives/hormone replacement). However, he said, it is not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It’s likely that breast cancer is caused by a complex interaction of genetic makeup and environment.

Regarding signs and symptoms of breast cancer, Dr Asad Pervaiz said that a lump in the breast or thickening that feels different from the surrounding tissue, change in the size, shape or appearance of a breast, fluid/blood coming from the nipple, dimpling in breast skin/in-drawing of nipple, or a red/scaly skin.

Regarding diagnosis of breast cancer, he said that it is advisable that when someone feels any of the above signs & symptoms, they should consult a doctor. It is very rare that a doctor by just examination can tell for sure that breast lump has cancer or not. Hence almost invariably, doctors would take help from tests such as mammogram, ultrasound scan and needle biopsy. “One big myth that needs demystifying is the common belief that needle biopsy can spread the cancer: There is no reality in this. It is only by having the test that one can have the diagnosis and treatment,” he added.

He revealed that breast cancer can occur in both men and women, but it’s 100 times more common in women.

Dr Asad Pervaiz informed that substantial support for breast cancer awareness and research funding has helped to create advances in the diagnosis and treatment. He said the survival rates have improved, and the number of deaths associated with this disease is steadily declining, largely due to factors such as early detection, personalised approach to treatment and a better understanding of the disease.

He said that the treatment is a combination of various therapies, including surgery, chemotherapy, radiotherapy, hormone treatment and targeted therapies. Not every patient needs all of these; however, it’s a careful combination of some of these treatment modalities that serves the purpose. They are usually administered sequentially, he added.

Speaking about mastectomy or removal of complete breast tissue, Dr Asad Pervaiz said that mastectomy has been the traditional treatment of all breast cancer patients in last century. However, with advances in technology and healthcare worldwide, smaller lumpectomy operations (only removing cancerous lump) are equally good.

At Shaukat Khanum Cancer Hospital Lahore, Dr Asad Pervaiz said, we offer lumpectomy surgery to over 70% of patients. The remaining 30%, who require mastectomy, are selectively offered breast reconstruction – where new breast is surgically formed using breast implants or flaps (body’s own tissue transferred). A recent study confirmed much better physical & psychological recovery in patient who underwent breast reconstruction.

Giving his piece of advice on how to respond to this challenge, Dr Asad Pervaiz said that early detection and timely/appropriate treatment is the key to success in breast cancer. He said that annual mammogram from the age of 40 can be useful, as some of the features of breast cancer can be picked up early even before lump forms.

He emphasised the need to encourage women to take out five minutes for self-examination every month. If someone feels a breast lump/other symptoms, he/she should immediately consult a qualified doctor and insist to have tests. No one should give false assurance, as sometimes a lump that does not feel like cancer, has actually got cancer. So, appropriate tests must be done to rule out cancer.

He urged the policymakers to focus their strategies on providing timely access to breast cancer treatment, as well as to sensitize people, especially women, through awareness campaigns.

In Pakistan, Dr Asad Pervaiz said, every year thousands of women lose their lives due to lack of awareness, several women do not share their health issues with others and are shy to go for breast examination. At Shaukat Khanum Memorial Cancer Hospital & Research Centre, he said, we provide holistic care to patients ensuring that every patient feels comfortable about it. We provide state-of-the-art diagnostic and treatment facilities, including chemotherapy, surgery, radiotherapy and more advanced targeted treatments. Our surgical department offers all the latest surgical techniques, including mammoplasties, wire guided surgeries, sentinel lymph node biopsy (SLNB), fat transfer, breast reconstruction (implants & flaps) & nipple reconstruction.

At Shaukat Khanum, Dr Asad Pervaiz informed, all our patients are treated through WHO endorsed multi-disciplinary team (MDT) approach. “We stand along with patients throughout their journey safeguarding their physical as well as emotional needs and our patients know that they are not alone in their fight against cancer,” he concluded.