PAKISTAN: Uphill struggle in battle against breast cancer

Photo: Sumaira Jajja/IRIN

Many Pakistani women are scared or shy to be examined by doctors

KARACHI, 4 November 2009 (IRIN) - Anecdotal evidence suggests breast cancer is on the rise in Pakistan but budgetary constraints, bogus healers and a lack of awareness is hampering early diagnosis, according to healthcare professionals.

“While we do not have any official data on breast cancer, from my experience I have seen the numbers go up,” said Rufina Soomro, consultant general and breast surgeon at the Liaquat National Hospital (LNH) Breast Clinic in Karachi, one of the country’s leading breast cancer treatment centres.

LNH records shows that in 1994, 1,574 patients visited the clinic and 28 breast cancer surgeries were performed, whereas in 2008, 11,644 patients visited the clinic and 244 surgeries were performed.

A 2008 report by the Pink Ribbon Campaign Pakistan said 90,000 new breast cancer cases are detected annually, and the disease caused 40,000 deaths a year in an estimated population of about 172 million.

Breast cancer is a disease that is physically, psychologically and financially draining. The whole family unit is hit hard if a female is diagnosed with it

Entitled A Life Worth Living, the report said Pakistan had the highest rate of breast cancer in Asia and spent the lowest percentage of its gross domestic product on health - 0.57 percent. In Pakistan, about one in nine women is likely to get breast cancer at some point in their lifetime, while in India it is one in 22, the report said.

According to information gathered by IRIN at two of the biggest government hospitals in Pakistan - the Civil Hospital Karachi and Jinnah Postgraduate Medical Centre (JPMC) - one in five female patients screened for breast cancer was positive.

The LNH’s Soomro said there was an alarming rise in the number of breast cancer cases and that the situation was made worse by alternative treatments and misconceptions.

“People shy away from this topic. When I came back to Pakistan and joined a public sector hospital, I was stopped from using the resource material I had brought from the UK as it was deemed culturally unsuitable… Things are better now but still there’s a long way to go,” she said.

Soomro said the government needed to do more to promote breast self-examinations and the usage of mammograms. She also recommended that gynaecologists, lady health visitors and general practitioners guide women on how to examine themselves.

Photo: Breast Cancer Care

A healthworker in rural Pakistan helps spread awareness of breast cancer

Faith healers

“Breast cancer is a disease that is physically, psychologically and financially draining. The whole family unit is hit hard if a female is diagnosed with it. In the long run for treatment to be successful, a patient needs the maximum support of her family. But people generally are so scared they resort to alternative treatments. Going to a `pir’ [faith healer] is very common and so is the use of homeopathy. By the time women come to us, the cancer is in later stages,” Soomro said.

‘Pirs’ are believed to be intermediaries between Allah and the community. There are thousands of them across Pakistan, with millions of followers, particularly in poorer rural areas.

Breast cancer survivor Suriya Suleman, 45, said when she first felt a lump in her breast she ignored it until the pain became unbearable, even with painkillers.

“My mother took me to a `pir’ who gave me some herbs and an amulet saying that the pain would go away. It never went away and then I moved on to homeopathy for a while. I finally went to a doctor when the breast started looking really bad and that’s when my worst fears were confirmed,” she said.

Having breast cancer proved to be more than a health problem for Suleman. “Our finances drained and I could not undergo a breast reconstruction. Moreover, my husband found a younger, `complete’ wife, although he insists that it was kindness on his part that he did not divorce me. I made it through thanks to my children and the support of my doctor,” she said.

Photo: Kamila Hyat/IRIN

Traditional roadside healers, such as this one, often claim to be able to cure breast cancer and HIV/AIDS among other things

Taboo

While `hakims’ (traditional doctors) and homeopathic practitioners distribute pamphlets claiming to cure breast cancer, the disease continues to be taboo in Pakistan’s mainstream media.

A content producer for a private TV channel, who requested anonymity, said breast cancer was a sensitive issue for TV. “Breasts are a very sexual part of the anatomy and it’s hard to get away with talking about them. On TV shows when issues like pregnancy are discussed, people call us up and complain,” he said.

But slow progress is being made. Throughout October, the internationally accepted breast cancer awareness month, TV stations dedicated segments to breast cancer awareness in their morning shows.

Breast cancer survivor Suleman feels much more should be done. “I wish the media was open about this issue. We show people fondling in soaps and music videos, so why is it that a woman touching her breast for detecting a lump is considered a no-no?”

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