couple of years back, a 46-year-old habitual smoker visited a pulmonologist in Karachi after experiencing persistent coughing and difficulty in breathing. Alarmed by his X-ray results, the doctor advised a biopsy to confirm or rule out lung cancer. The patient refused to comply. His reason? The common misconception that “a needle touching a tumour causes cancer to spread rapidly.” Despite warnings from the pulmonologist, the patient left the clinic.

Several months later, he returned in a critical condition, struggling to breathe, only for the doctor to discover that the cancer had spread to other organs, rendering it nearly untreatable.

This story is far from unique in Pakistan, where misconceptions about biopsies remain pervasive among cancer patients. Refusing a biopsy, a critical diagnostic tool for cancer, is a regular occurrence, particularly among patients in the early stages of the disease. In the fight against cancer, timely diagnosis through biopsies remains one of the most critical steps. Misconceptions about the procedure are costing lives every day.

Senior pulmonologists and oncologists report that nearly 20 percent of the cancer patients decline biopsies against medical advice. Many of these patients hold on to the dangerous belief that the procedure will “awaken the beast” and cause the cancer to become more aggressive.

Prof Sohail Akhtar, a senior pulmonologist at Indus Hospital in Karachi, says that this misconception about biopsy procedures is a major challenge in diagnosing and treating cancer in Pakistan. “A majority of patients who refuse biopsies have heard about someone whose cancer progressed after a biopsy. They don’t realise that for those people the cancer was already at an advanced stage,” he says. “Biopsies are crucial for an accurate diagnosis.”

Late diagnosis is a major problem in Pakistan’s fight against cancer, particularly breast cancer. More than 40,000 women die each year from breast cancer in the country. Breast cancer accounts for about 38 percent of all cancer cases among women in Pakistan. One of the reasons for the high mortality rate is that many women seek medical help when the disease is in an advanced stage, leaving little room for effective treatment.

Breast cancer is the most common cancer among women in Pakistan, with nearly 90,000 new cases reported annually. The mortality rate remains alarmingly high, with around 40,000 deaths each year, largely due to late diagnosis and a lack of awareness. Research indicates that the survival rate for early-stage breast cancer is around 90 percent. This ratio drops significantly when diagnosis occurs in the later stages, when the cancer has metastasised to other organs.

Dr Aasim Yusuf, chief medical officer at Shaukat Khanum Memorial Cancer Hospital in Lahore and Peshawar, has encountered countless patients who share the same misconception about biopsies.

“Patients come in with advanced-stage cancers, and when we suggest a biopsy, they argue that it will cause the cancer to spread. But without a biopsy, we can’t even confirm if it’s cancer, let alone determine the best course of treatment,” Dr Yusuf says.

The SKMCH has long advocated for the importance of biopsy procedures. “We never start chemotherapy without a biopsy. It’s a critical step not only for diagnosis but also for understanding the type of cancer and determining the most effective treatment,” Dr Yusuf says.

A biopsy is the only definitive way to confirm a cancer diagnosis. While imaging techniques such as X-rays, ultrasounds and mammograms can suggest the presence of a tumour, a biopsy involves extracting a small sample of tissue from the affected area to determine whether it is cancerous. Biopsies are essential for identifying the type of cancer, which is critical for tailoring the treatment plan. For instance, in lung cancer, there are four major types, each requiring a different treatment. Without a biopsy, oncologists cannot determine which type of cancer a patient has. This can cause delays in starting the appropriate therapy.

“A biopsy can also rule out cancer,” says Prof Akhtar. “Sometimes conditions like tuberculosis present similarly to cancer; without a biopsy, we can’t make the right diagnosis.”

Modern biopsy techniques, such as needle biopsies guided by X-ray or ultrasound, are minimally invasive and generally safe. Yet the myths surrounding the procedure persist, particularly in rural areas where access to accurate health information is limited.

The fear surrounding biopsies is often rooted in cultural beliefs and misinformation. Many people in Pakistan, particularly in rural areas, rely on anecdotal evidence and advice from family members or friends rather than consulting medical professionals. For some, the belief that biopsies cause cancer to spread is so deeply ingrained that repeated assurances from doctors are not enough to change their minds.

Dr Amina Khan, a surgical oncologist at Shaukat Khanum Hospital in Lahore, encounters this problem frequently. “15-20 percent of patients come in with the belief that if a needle touches their tumour, it will spread throughout their body. We explain the procedure in detail and offer reassurances. However, many patients still refuse to return for further testing or treatment.”

The consequences of these misconceptions are dire.

“I’ve seen patients return months, even years, later. By then, the cancer has become incurable,” Dr Khan says, visibly frustrated by the situation. “People are being misled by these myths and it’s costing them their lives.”

Early diagnosis is crucial for improving survival rates. Biopsies, as part of the diagnostic process, are key to catching cancer in its early stages when treatment is most effective.

However, a fear of invasive procedures and mistrust of medical professionals create barriers to early diagnosis.

“For breast cancer, which affects 1 in 9 women in Pakistan, early detection through regular screenings and biopsies can save many lives,” Dr Amina Khan stresses.

Breast cancer screening programmes, though available in most urban centres, are still less widely available in rural areas. Many women only seek help when the disease has reached an advanced stage.

Dr Khan adds that “in breast cancer, a biopsy helps determine the specific type of cancer, guiding treatment choices—whether chemotherapy, radiation, or surgery is the most appropriate option.”

To combat the dangerous misconceptions about biopsies and improve cancer outcomes, healthcare professionals across Pakistan are calling for widespread education and awareness campaigns. Hospitals and healthcare providers are also working to make cancer screenings and diagnostic procedures like biopsies more accessible, particularly in rural areas where healthcare services are limited.

“We need to start by educating people at the grassroots level,” says Dr Aasim Yusuf. “Once the public understands the importance of early diagnosis and how biopsies fit into that, we can begin to see a shift in outcomes.”

The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International