At the breast clinic at Ganga Ram Hospital, a doctor is going through the reports of a woman sitting before her on the patient’s stool. She checks her physically as well.

"Your reports aren’t okay," the doctor murmurs.

"Yes, I am aware of that," says the woman, who must be in her early 40s.

"How did you guess?"

"I had this feeling that something was going wrong."

"Then why didn’t you come in for an early checkup?"

"I had no pain. I still don’t," says the patient.

"You know, we shall have to operate upon you," the doctor replies.

It’s been observed that women do not report the appearance of a lump or any change in their breast(s) easily. They are ashamed to expose themselves even before the doctor.

Ganga Ram Hospital’s breast clinic, the first in the city, has all women doctors and a woman technician. There are two women in the radiation section as well whereas a similar department at Shaukat Khanum Memorial Cancer Hospital (SKMCH) boasts an all-male staff.

"More women need training to be technicians. It’s unfortunate that there is no lady here," complains a woman who is undergoing radiation at the SKMCH post breast surgery. Also, there are very few women oncologists and radiologists around.

The three doctors that are examining the patients at Ganga Ram breast clinic as a team say that most patients report very late -- six months to one year -- after they have detected something wrong with their breast(s). Even the educated people go for dum darood instead.

"A woman who turned out to be an MBA, went to a maulvi for treatment after she was diagnosed with breast cancer at the hospital," says a doctor. "Many hakeems and maulvis are said to be ‘treating’ the ailment. God knows they are incapable of treating any ailment, let alone cancer. There is something deeply wrong with our society."

Two women who have come in for a check-up confirm they had tried other methods. They also regret that didn’t see the doctor at an early stage.

"Mastectomy is hugely dreaded. Most patients fear it will prove to be fatal which is absolutely ill-founded," says a doctor at the clinic. "Proper treatment is a must, so is chemotherapy whenever it is advised. A patient who chooses to skip the treatment is only wasting his time and complicating the matters."

Lack of resources is one major issue. As the treatment is done in several stages, most patients do not make it through, generally because they cannot afford the expensive medicines. Surgery at the clinic is free, though.

According to Dr Abubakar Shahid, Director Institute of Nuclear Medicine and Oncology (Inmol), an institute run by the Pakistan Atomic Energy Commission of Pakistan (PAEC), "Eighty per cent of lumps are found to be benign, only 20 per cent are malignant. That means 8 out of 10 women do not have cancer."

A woman should conduct self-examination every time she takes a bath, go to a breast clinic if she spots a lump or some sort of hard cyst in a breast or in the underarms, change in breast size or colour. Itching, warm temperature of breast, discharge from nipple and pain call for the doctor’s attention. In hospitals such as SKMCH, Inmol and Fatima Memorial there are free booklets available for those who want to learn how to conduct a self-check.

In Lahore, breast clinics operate six days a week at Inmol, SKMCH, Ganga Ram and Fatima Memorial Hospital. The breast clinic at Mayo Hospital, which operates only two days a week, also complains of receiving late cases. Last year, Lady Aitchison Hospital in the city also started its own breast clinic.

If your mother, sister, paternal or maternal aunt or a grandmother had cancer, then you need to be more alert about any warning signs because the risk of breast cancer increases if a close kin had it, says a doctor who does not want to be named.

"Out of every 100 women diagnosed with cancer at Inmol, 40-45 have breast cancer. Lately, it is being detected in young women also. The problem is that women mostly do not report until it is too late. The ones that Inmol receives are largely in stages 3 and 4," he adds.

"Early detection is very important. There are 90 per cent chances that you could be cured if the treatment starts well in time."

The breast clinic that was started at Inmol in 2004 saw patients two days a week initially. Now it operates throughout the week with more women coming in for check-up. Thirty to forty women come daily, mostly on detecting lump in breast.

Fine-needle aspiration (FNA) biopsy is conducted to ascertain the nature of lump wherever required. The doctors dispel fear of any danger in insertion of needle in the body. "FNA is safe. Any fear among women about biopsy is misplaced."

A number of hospitals in Pakistan have breast clinics where women can go for check-up if they suspect anything wrong but the PAEC hospitals in different parts of the country -- 18 in number now -- are treating 80 per cent of cancer patients. At their breast clinics, all the staff is female.

"Breast cancer is the most common cancer in women, responsible for almost 20 per cent of all cancer deaths in women. It is more common among women after age 40," says a PAEC brief on breast cancer in its October 2015 report.

The cost at PAEC hospitals is one tenth of private hospitals. The radiation services start at 7 in the morning and continue till 10 at night. Patients who can’t afford the treatment get further discount. Many patients get 50 per cent discount and in some cases even more.

An activist associated with Pink Ribbon, an NGO working for breast cancer awareness since 2004, says there has been 30 per cent increase in visits to breasts clinics. Television channels that were not willing to talk about breast cancer a decade back are doing it now. So, attitudes seem to be changing.

October is observed as the month to disseminate information about breast cancer, to prompt women to attend to their health in time. Scheduling annual mammograms after the age of 40 is strongly advised. As part of National Breast Cancer Awareness Campaign, October 25 is further recognised as Mammography Day.