reast cancer is a pesky interloper that has a cruel habit of cutting lives short in the most unfair of ways. It can sit silently in a person’s body, spreading its tentacles till it eventually strikes with vicious force. It can take over the lives of those in treatment as well as those around them for months, if not years. It can ravage the body and spirit of the patient and leave a permanent scar on the hearts of their loved ones.

But it doesn’t have to.

If detected early, the disease is fairly easy to control with extremely promising chances of survival. But in a country like Pakistan, where awareness levels are low and the healthcare system severely lacking, the outlook is often more grave. By the time most women realize they have the disease, it is already at an advanced stage and far more difficult to manage.

“As a nation, there is a delay in diagnosis and many patients do not survive because by the time they are diagnosed their disease is late-stage,” Dr. Muhammad Arif tells Instep. He is the owner of the Razia Sultana Memorial Cancer and Blood Associates clinic, named in honour of his late mother who also battled the disease.

So what exactly is this nasty malady that seems single-mindedly hell-bent on causing misery? Cancer is basically a group of diseases characterised by the uncontrolled division of cells (which are the basic building blocks of a living being). And what causes this unregulated cell multiplication? “There are a lot of theories,” Dr. Arif replies. “The old theory was that this is genetically determined. But after research into DNA and mutations, we found out that cancer is not necessarily genetic. It is mostly caused by metabolic problems in the body which then trigger cell growth.”

According to the oncologist, about seventy percent of cancers in general are now attributed to lifestyle issues, such as what we consume and how active we are.

Our diet, he says, is one of the fundamental driving forces behind the ailment. “The so-called industrial diet of today, products which are far from natural foods, [damage our bodies],” he explains. He lists the overconsumption of sugar and sweets, bakery products, vegetable oils, chicken and other meats, and Western-style junk food as contributing factors and explains that we simply are not used to the chemically processed items we are now consuming. “We have evolved millions of years to get to this level, but in the last 100 years or so, our diet has been turned upside down. Things like over-processed oils are a huge factor in this, as are the chemicals and preservatives that are used to enhance the taste and shelf life of food [but that aren’t good for the human body].”

Unhealthy and fatty diets alongside a lack of activity, like exercise and walking, lead inevitably to weight gain. “In breast cancer, one of the highest risk factors is obesity and inactivity,” he says. Stress can also make the disease worse in patients who already have it. And then there are elements that cause a disruption in our internal metabolism but which we can’t easily influence, like our environment, the toxic chemicals that have been sprayed on the vegetables and fruit we consume, fertilizers, pollution, and water supplies contaminated with factory runoffs.

Specific to breast cancer, a woman’s familial history (first degree relatives with breast cancer) as well as reproductive history (early menarche, late menopause, and late first pregnancies) are often cited as risk factors.

“Cancer is not necessarily genetic. It is mostly caused by metabolic problems in the body which then trigger cell growth.” – Dr. Muhammad Arif

Altogether, these elements play a role in triggering a disease that disrupts the lives of millions of women – and even some men – every year. According to the World Health Organization, in 2020, there were 2.3 million women diagnosed with breast cancer as well as 685,000 deaths globally. While real data about the prevalence of breast cancer in Pakistan is not available, Dr. Arif says that according to estimates, about 1 in 7 or 8 Pakistani women will develop this disease in their lifetime, with Pakistan being among the highest risk countries in the breast cancer category worldwide.

Detecting the disease in its earliest possible stage is the best way to combat this life-threatening adversary. And awareness of the symptoms certainly helps. “The most common sign of breast cancer is a lump in the breast. Sometimes there is a discharge from the nipple, swelling, or skin discolouration,” the doctor details. If the disease has spread, then it can cause any sign or symptom anywhere in the body, like pain in the back or in a bone (bone metastasis), a cough (if it has spread to the lungs), or swelling in the neck (if there are tumours in the neck nodes). “I think, as a general rule, any symptom that is new and persists beyond a few weeks should be investigated properly by a qualified physician,” he says.

Thanks to scientific advances, we now have several treatment options for breast cancer. Surgery can remove a tumour; chemo-therapy kills cancer cells with medication; radiation therapy sterilizes the area affected by the disease and destroys the cells responsible for the growth; and targeted treatment, like hormone therapy and immu- notherapy, attacks specific elements to slow down or eliminate the growth.

Treatment options are dictated by how advanced the disease is. If diagnosed at an early stage, the treatment is likely to be less taxing and more effective. With metastatic disease, surgery is no longer an option, and the symptoms are basically managed with medication and radiation but the intent is generally palliative and no longer curative.

“Stage I breast cancer – where there is a small tumour in the breast which is less than 2 centimetres in size – has an 85 percent rate of survival. In Stage II, the chances of survival go into the 60s and 70s. Once it’s Stage III, it’s not only in the breast but is in the axilla as well, having spread through the lymph nodes, and the survival rate drops to less than 50 percent. When the disease is at Stage IV and has gone beyond the breast region and spread to another organ, then the five-year survival is less than 10 percent.”

Dr. Arif strongly suggests that women, especially those who have close relatives – mother, sister, aunt – with breast cancer, pay special attention to any and all changes in their breasts. “In other countries, there is a lot of screening which leads to early detection and people get treated. [The lack of screening here] is a major factor why our mortality rate is very high,” he says.

“By Western standards, the recommendation is that any woman who has a strong family history of breast cancer should get a mammogram every year after the age of 50. In the Pakistani context, I think it is not feasible to perform a mammo on every woman every year [because of high costs and lack of facilities]. So, I think the most important thing for a woman would be to pay attention to the symptoms, pay attention to any lump they feel in the breast, and get the lumps investigated with an ultrasound and mammogram immediately.”

He also reasserts that special attention should be paid to prevention. “[It is essential] to take care of the lifestyle factors, like a proper diet, weight control, exercise, and stress management. Then there is self-examination; if you notice anything new, any symptoms at all, try to pay attention to it right away so that there is no delay. Early diagnosis could save lives.”

So try your best to take good care of your bodies. And no matter what your age, gender, or lifestyle habits – this disease can affect anyone, irrespective of their risk factors, after all – monitor any changes in your breasts (or elsewhere), get regular clinical examinations, follow the advice of the experts, and encourage your family and friends to do the same. Be vigilant, and spread the message. It could ultimately make a world of difference.