1 in 8 women get breast cancer. Today I’m the one,” actress Julia Louis-Dreyfus wrote in a social media post in September 2017. Her disease was diagnosed at Stage II; that is, the cancer was confined to the breast area. In the subsequent months, she underwent six rounds of chemotherapy and a double mastectomy. A year later, she revealed she was in remission.

Singer Sarah Harding wasn’t as lucky. After putting off a doctor’s visit at the beginning of the Covid-19 pandemic when she first noticed symptoms, the Girls Aloud star eventually ended up battling Stage IV breast cancer – advanced disease that had spread to other parts of the body and was effectively terminal. She succumbed to the ailment in September this year.

Around the globe, breast cancer is busy casting a shadow on the lives of numerous women (and even some men). According to the World Health Organization, 2.3 million women were diagnosed with breast cancer last year and the disease was responsible for 685,000 deaths worldwide. But as daunting as these numbers may seem, the situation is not hopeless; far from it. Thanks to advances in medical science, women now have more treatment options than ever before. And therapy can be highly effective, given just one caveat: the disease is identified early.

“We lose very few patients in early-stage breast cancer because we have really good treatment,” a scrubs-clad Dr. Amina Khan tells me on a busy Friday morning. She is a consultant surgical oncologist at Shaukat Khanum Memorial Cancer Hospital and Research Centre, where she has spent over 15 years helping save lives. “Breast cancer treatment in Stages I and II has a more than 94 percent success rate,” she continues. “Even Stage III now has a really good prognosis. Only Stage IV – that is, metastatic disease – is where we are not doing so well.”

In all its many forms, cancer – the result of a disturbance in our internal checks and balances due to which the body loses control of when to stop cell multiplication – ranks among the most prevalent diseases that plague our bodies. But we have come a long way in how we tackle this so-called emperor of all maladies. Surgery excises the malignant tumour; chemotherapy drugs kill the excess mass as well as the cells generating this new growth; radiation therapy zaps the mother cells that are producing the growth; and targeted treatment counters specific proteins on the cancer, destroying the abnormal cells without harming the normal ones and thereby reducing side effects.

Of the over 100 types of cancers that affect humans, breast cancer is the most frequently occurring. And Dr. Amina opines that this is actually a good thing. “Some cancer had to have the highest incidence. Fortunately it’s breast cancer. And I would say fortunately because it is one of the cancers that we know how to treat.” There are cancers – like pancreatic and lung – where the prognosis is dismal. But with breast cancer, the situation is far more optimistic. “We have made such tremendous progress in treatment that now for early-stage disease, we are almost talking about a cure for breast cancer.”

That is precisely why it is important to catch the disease as early as possible. Awareness of the symptoms certainly helps. The most common sign, of course, is a lump. “A lump is an abnormal thickening or an area which is harder or firmer than the rest of the breast,” Dr. Amina explains. “Breast cancer lumps,” she elaborates, “are generally painless. That’s why breast cancer is called the silent killer. Breast cancer grows silently; it [usually] does not cause any pain. It’s just completely [mute] till it becomes a really aggressive tumour.” Also worth noting, she points out, is that despite a very common misconception, such lumps and bumps are not normal during pregnancy and breastfeeding and they need to be monitored. Basically, every lump that a woman feels in the breast needs to be biopsied, she opines.

“Other signs,” she continues, “can be skin changes, a rash that doesn’t go away, a nipple that becomes excoriated, ulcerated, or starts bleeding, and lumps in the armpit area.”

To notice these changes, women need to be more aware of their bodies, which is only possible if we check ourselves regularly. Self-examination is recommended for women in their 20s and 30s, a baseline mammogram is advised between the ages of 35 and 40, while yearly (or every other year if there are financial constraints) mammograms are suggested for ladies aged 40 onwards. “In Stages I and II, the lumps are so small that you can hardly feel them. The hand of the patient or doctor is not sensitive enough to pick these tiny cancers which we want to find. The only way to find them is imaging through mammograms and ultrasounds.”

More meticulous surveillance is advised for individuals with a higher risk of developing breast cancer. “There are unmodifiable risk factors – ones that we can’t change but we really need to know about so that we can be cognisant that our risk is high or low – and modifiable risk factors – factors that we have a control over and can change.”

Unmodifiable factors, Dr. Amina details, include the female gender (99% of breast cancer will happen to women; only 1% in men), increasing age (there is low incidence in the 20s and 30s; the risk starts escalating in 40s and 50s, and becomes really high in 60s), having a family history of breast cancer (especially first degree relatives with breast cancer or other cancers; BRCA mutation testing is advised in such cases), mutation in certain genes, and our hormonal milieu (higher risk for girls who develop early and reach menarche at a young age, women who reach menopause at a late stage, women who don’t have children or have their first child very late and perform less breast feeding).

Modifiable factors, on the other hand include everything that goes with a healthy lifestyle: “lots of sleep, healthy diet, regular exercise, maintaining your weight within the average BMI range, no alcohol, no smoking, no sedentary lifestyle.”

“In Stage 0, the cancer is handled with surgery and radiation, and hormone therapy if it is hormone receptor positive, but there is no chemotherapy, so that is huge. Similarly for early Stage I, there is no chemo. In late Stage I and Stages II, III, and IV, chemo comes in as well as all the toxicity [and side effects] that come with it. And when the tumour burden is higher and there is more cancer to fight, it can spread to other parts of the body. You’re trying to kill it in multiple spots, and then it becomes difficult to handle,” she reiterates.

So ladies – and also gents – be vigilant. And encourage your loved ones to do the same. We may not have conquered this nefarious disease altogether just yet, but we can still defeat it. And ultimately, it’s early detection that can make a world of difference.

“Early detection leads to longer
survival rates and reduced mortality and morbidity.” – Dr. Ayesha Isani Majeed

When you speak to Professor Ayesha Isani Majeed, you can immediately tell just how passionate she is about her work. She is the head of Radiology and the head of the Federal Breast Cancer Screening Centre at the Pakistan Institute of Medical Sciences in Islamabad, where she has been working towards providing women with free screening facilities. And you can tell just how important her work is when you see what a big difference screening can make.

“Early detection leads to longer survival rates and reduced mortality and morbidity,” she tells Instep. The survival rates for Stage I and II breast cancer, according to the statistics she has shared, are above 98 percent and 95 percent respectively. But the numbers fall as the stages advance. Stage III has a survival rate of 60 to 70 percent, while Stage IV sadly sees a further decline to below 50%. “[Unfortunately,] in our country, women usually come with Stage III and Stage IV cancer. Screening can help us detect the cancer at Stage I and Stage II [which vastly improves the prognosis].”

Women are encouraged to monitor their breasts by performing self-examinations and also getting clinical examinations wherein trained health professionals – like nurses, lady health workers, general practitioner, and specialists – physically check the breast for lumps and changes.

Breast screening tests are also highly recommended. Below the age of 40, ultrasounds are advised, while women over 40 are suggested to get mammography. “Recently with younger women getting breast cancer, the American College of Radiology has advocated that mammography can be started at 35 for those who are at high risk and have family history,” Dr. Ayesha informs.

To help women with this testing, the Federal Breast Cancer Screening Centre offers free screening facilities all year round, six days a week, and the centre hopes to continue its work while raising awareness regarding the importance of screening for early detection.

“Pakistan has a higher rate of breast cancer than any other Asian country,” Dr. Ayesha says. “One in every 9 women suffers from breast cancer. According to the Global Cancer Observatory, 34,000 women are diagnosed with breast cancer [in Pakistan every year], a number that will double in 2040 to 64,000. The establishment of a ‘one stop breast clinic’ is the answer to the cultural, financial, mental, and physical needs of the women of Pakistan, so that triple assessment can be performed by a surgeon, radiologist, and pathologist under one roof in a single visit. We aim to make the Federal Breast Cancer Screening Centre a role model for other such similar centres in different districts of Pakistan so that this lethal disease is eradicated at the grassroots level.” We hope, for all our sakes, that they manage to achieve just that. – S.A.