We’re in October again. The month of breast cancer awareness campaign. The month of pink ribbons, pink buildings and pink ad and brochures.

Come October, and we’re reminded that every year about 90,000 women are diagnosed with the disease and some 40,000 lose their lives to it; Pakistan has the highest rate of breast cancer occurrence in Asia; one in nine woman is at the risk of contracting it, whereas in India one in every 22 gets it. "These are underreported figures," says Omer Aftab, CEO, Pink Ribbon, an NGO working on breast cancer awareness, diagnosis and treatment.

"These statistics are based on the number of women that have accessed treatment at hospitals in Pakistan. We do not know how many more women are out there with breast cancer who have not reached hospitals due to social stigma or any other reason. Also, after the latest census, these statistics may have changed," he adds.

These could be incorrect statistics. "We are not scientifically qualified to make that statement in the absence of authentic cancer registry," reiterates Professor Shaista Masood Khan, Head of Breast Section, Department of Surgery, Aga Khan University.

In Pakistan, she adds, the average age of women getting this disease is 40, in the West it is 50. "So, definitely, our women are contracting it 8-10 years earlier than those living in the developed countries. We also see women patients in 30s, but that age group is not in bulk."

Aftab says the disease is being diagnosed among very young girls as well, even as young as age 18.

Another reason hindering the collection of accurate statistics is that women in our culture do not talk about this disease. They hesitate to even mention the word ‘breast’. It’s just too private. "Typically, in Pakistan a woman will not disclose even to her dearest ones that she’s been detected with breast cancer. And if the dear ones know, they will try to hide her condition from the outside world. This prevents them from accessing treatment," he says.

This mindset is prevalent even in the educated, elite class of the society. "The worst is they’d rather marry off their daughter than treat her. They believe ignorance is bliss. They associate breast cancer with a woman’s evil deed," he adds.

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This is not scaremongering. We all have a friend, a relative who’s tested positive for breast cancer. Denying an explosion in the number of breast cancer occurrences would be stupid. So, what are we doing about it? We don’t even know what causes it.

We are told everything and nothing causes breast cancer. Women who’re childless have a higher chance, so do women who have not breastfed, are obese and have had children late, have a family history or are on hormone replacement therapy. And so do women who’ve had late menopause, been on contraceptive pill and started periods too late or too early. Then the bra factors creep in -- wearing the bra for too long during the day or selecting a wrong one can increase the risk of getting breast cancer.

Latest studies suggest that injecting steroids in cows and buffalos during lactation is directly impacting the estrogen levels in women. Estrogen is linked to breast cancer. Additionally, sugar is highly cancerous.

Myths around the cause of breast cancer abound. But evidence for these doesn’t always stack up. "Most of the risk factors cited in global research, such as late marriage, number of children, etc, are not applicable in Pakistan," says Khan, continuing that lack of research in Pakistan on breast cancer is a real problem. "Research in bits and pieces is only giving out wrong signals. We need to do something on large scale. We know occurrence of breast cancer among Polish jews is high because of their genetic mutation. We do not know what’s causing the disease in Pakistan. We need to look at our nutrition and genetic mutation."

Because of this ambiguity, early detection has become the recommended method to prevent a fatality. Breast cancer responds to treatment very well. There’s a 90 per cent recovery chance in early cases, and even in cases of last stage treatment can help them live a comfortable life.

"Self-detection is the first and a very important step. Girls as young as 18 must conduct breast examinations periodically. At any age, a lump cannot go unnoticed, even if you’re breastfeeding. By age 40 you are supposed to get mammograms every two years. Mammography helps identify growth at a stage when it is not even palpable," explains Dr Amina Iqbal Khan, surgical oncologist at the Shaukat Khanum Memorial Cancer Hospital.

She feels awareness is rising; medical institutions are sending the message to women to check out their breasts -- "and because of this women are now coming out and saying, ‘Oh, there’s something wrong with me. Can you check?’ This is definitely leading to early detection of breast cancer. I’ve seen a change, our community is far more educated now than 10 years ago. It’s a slow change but a definite one."

Over the years, the treatment of breast cancer has come a long way from knowing that mastectomy was the only form of treatment to conservation of breasts. "Today, we are doing more breast saving surgeries than mastectomies. We have saved breasts of about two thirds of patients. Even in cases of mastectomy we have begun to offer construction," says Dr Amina Khan.

Although breast cancer is common in Pakistan, it is not the number one cause of deaths. Shaista Khan believes Pakistan is not addressing this disease in an organised manner. "Screening of women living in far off areas must be conducted through satellite setups or at family planning institutions. We have to prevent deaths from breast cancer. We have to save breasts."

At an average, the treatment of breast cancer cost Rs400,000 to 500,000. She says the state must agree to offer this kind of funding to save lives. But, she insists, "early detection is the only solution to cost-effective treatment".

A dearth of training of medical practitioners further complicates the situation. We may have women trained to conduct physical examinations and mammography but the number of female surgeons is very low. "Women often hesitate in getting surgeries done by male surgeons," adds Shaista Khan.

Omer Aftab thinks if the government could control dengue, it can prevent breast cancer, too. "The government has turned its back to it just because this is thought to be a women-related disease. We do not have an organised cancer control programme in the country."