Breast cancer is the most common cancer amongst women throughout the world. It can be a life-threatening illness, inflicting terror in one in nine women in Pakistan throughout their lifetime. Fortunately, the survival rate of an invasive breast cancer is 99% if early detection is timely and successful.
Published in The Express Tribune, October 3rd, 2020.
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According to predicted statistics, the total projected breast cancer incidences will increase by approximately 23.1% in 2020 to 60.7% in 2025. Cases in younger women, aged 30-34 years, will increase from 70.7% to 130.6% in 2020 and 2025, in comparison to 2015. Previously, women aged 60-64 years had the highest overall breast cancer incidence rates, while from 2016 to 2025, significant increases in the rate are expected among women aged 50-64 years. Latterly, a majority of Asian population is expected to have a peak in breast cancer occurrences between ages 40-59.
Therefore, it is vital to know the signs and symptoms of breast cancer for an early detection. Signs usually involve a lump found in the breast or armpit, swelling or thickening of parts of the breast, dimpling or retraction of breast skin or nipples, any changes in breast or pain, and noticeable inflammation in any area of the breast. A mammogram can be conducted to detect breast cancer, any changes noticed on mammograms might be the first sign of the disease. Other diagnostic methods include MRI scans, breast ultrasounds, nipple discharge exam, and breast biopsy. In the case of breast cancer detection, other tests, such as a CT (CAT) scan, PET scan, or bone scan, are conducted to detect metastasis spread of cancer to other organs.
An early detection is vital for treatment. Being 99% curable, some other ways of treatment include surgery (lumpectomy, mastectomy, and axillary clearance), radiations, chemotherapy, hormone treatment, targeted therapy, and immunotherapy drugs.
Survivor stories are immensely motivating, radiating life and resilience. However, not everyone is lucky enough, including the case of Maria Khan, a young woman belonging to an underprivileged community in Pakistan. Maria lost her battle with breast cancer after three years of treatment because of delayed detection. In her family, talking about women’s health was considered a taboo. She was 35, a mother of four, when she found a lump and hardening of one of her breasts, but ignored it. After six months, she felt striking pain, and her breast became hard and tender. Due to her worsening condition, her husband bought her painkillers from a nearby local pharmacy.
A month passed by, and the pain became unbearable, and multiple lymph nodes also appeared in her armpits. She went to a doctor who recommended her for a mammogram, which ultimately showed malignancy. She was referred for further treatment. Her husband, a daily-wager, managed to pay for the breast surgery, but when the surgeon advised her for chemotherapy and radiotherapy, it became unaffordable. He then sought help from different religious clerics and delayed further medical procedures. Sadly, postponing chemotherapy had a poor outcome. She developed multiple nodes at the back of her neck and additional painful lump in another breast. When they reached out to doctors, it was already very late since her cancer had progressed to stage-IV and had metastasised in other organs.
Maria lost hope, and her last days were gloomy and painful. She died battling the disease for three years, leaving her family devastated. Early detection and treatment could have saved her life. The availability and affordability of medical facilities and timely referrals can save millions of precious lives globally.
Disseminating awareness through rigorous efforts is crucial to educate women about the prevalence of this disease, ultimately leading towards better outcomes of early detection, screening, and diagnosis. Three ways can increase our chances of detecting cancer at the earliest — knowing the dangers; a routine self-examination; and an immediate screening when concerned. According to statistics, with invasive breast carcinoma, the average five-year survival rate is 91%. The average 10-year survival rate is 84%, and if the cancer is only located in the breast, the chances increase to 99% of the 5-year survival rate of women.
Another empowering story of Muneeza Ahmed, a cancer survivor, is a living proof that early detection can save countless lives. Muneeza, 30, lives a happily married life today. One day she self-examined herself and felt a hard, painful lump under her breast. She had heard about the importance of early detection through awareness programmes on social media. Her acquaintances encouraged her to seek medical help. Muneeza was diagnosed with stage-I breast cancer through a mammogram followed by biopsy and mastectomy. She underwent treatment for three and a half years, including surgery, chemotherapy and radiation.
Amidst her condition, her greatest worry was her family and sons, now aged 14 and 12 years. Luckily, her husband was a prodigious support throughout her journey. Counseling also played a significant part. Today, Muneeza is fully recovered and leading a healthy life, advising others to never neglect a small growth, and look for signs and symptoms.
It is important to understand how breast cancer develops and its variations. It begins when cells in the breast start to grow abnormally. The most common type of breast cancer is ductal carcinoma in situ (DCIS), indicating the cancer cell growth starts in the milk ducts. Invasive ductal cell carcinoma (IDC) and invasive lobular carcinoma (ILC) are breast cancers indicating that cancer has grown out of its original place and is invading nearby tissues. Inflammatory breast cancer (IBC) indicates no solid lump but the redness and tenderness of breast skin. Triple-negative breast cancer (TNBC) is a type in which cancer cells are missing three kinds of proteins: estrogen and progesterone receptors, and a protein called HER2. This type of breast cancer is the hardest to treat.
Stages of cancer can prove to be critically significant in detection and proper treatment. There are four stages of cancer (I-IV). Stage-0 indicates non-invasive cancer where abnormal cells have been found in the breast milk duct. Stage-I cancer is evident, but abnormal cells are contained in the area. Rests of the stages are invasive, and as the disease progresses, treatment becomes challenging. Stage I is highly curable, typically surgery and often radiation or a combination of the two. Additionally, hormone therapy is also effective. An early detection and screening includes monthly breast self-examinations, scheduling regular clinical breast exams and mammograms.
According to The Daily Mail, “Counseling can double a woman’s chance of surviving breast cancer.”
Also regular sessions with psychologists reduced chances of the cancer relapsing and increased the time for the disease to recur. The real challenge, however, is to create awareness among Pakistani women for an early screening and detection, which leads to a better prognosis. Health experts, social activists, philanthropists, NGOs, and other stakeholders should spread awareness for early detection of breast cancer to save thousands of lives.
In this fight against breast cancer, it is vital we stay vigilant and aware. We need to join our collective forces to win this fight. It is crucial we empower our women to talk about their heath, issues and their concerns. We need to reach out to women suffering in silence, and extend our continuous support. Together we can win this fight, and defeat breast cancer.
Published in The Express Tribune, October 3rd, 2020.