October 22, 2008	Wednesday	Shawwal 22, 1429

KARACHI, Oct 21: Pakistan has the highest incidence of breast cancer in Asia and the situation is becoming alarming in view of the fact that more and more young women are falling victim to the disease.

Given the economic constraints the country faces, one important strategy that can help reduce the breast cancer risk to a great extent is to create awareness and train the lady health workers and paramedics in clinical breast examination.

These were some of the points highlighted at a seminar on breast cancer held at the PMA House on Tuesday.

Laying emphasis on early detection of the disease, speakers at the seminar said that it could help increase cure and survival rate as well as quality of life.

“It is worrisome to see the increasing number of breast cancer cases especially in young women. We can reduce the disease burden to almost half if a campaign is initiated to create awareness about the importance of breast self-examination and lady health workers and paramedics are trained in clinical breast examination. This can be a very important strategy to tackle the disease as there are monetary issues involved and it is difficult to provide ultrasound and mammography services free of charge,” said Dr Rufina Soomro, consultant surgeon at the Liaquat National Hospital.

She lamented that a large number of patients, including doctors and nurses, remained unaware of the disease at its early stage and consulted physicians only after the condition deteriorated.

“Women come up with large lesions and distorted breasts and say that they came to know about their breast’s condition a few days ago. This is utterly surprising. What we need to do is to teach young girls about breast self-examination as soon as they start getting their periods.”

She said breast cancer was most prevalent among women of 35 to 45 years of age and most women were diagnosed at a stage in which five-year survival rate was 48 per cent.

Giving the statistics about breast cancer in India and Pakistan, Dr Nehal Masood of Aga Khan University and Hospital said that out of 100,000 cases in India 19 were diagnosed with breast cancer while in Pakistan the incidence was as high as 50 cases per 100,000 patients.

About one in nine Pakistani women were likely to suffer from breast cancer. In contrast to western epidemiology, breast cancer here occurred at a younger age with larger lesion size and increased axillary nodal metastases.

According to the speakers, eighty-five per cent of the patients generally do not have any risk factors that include age (women over the age of 40 years are more vulnerable), early menarche, late menopause, late first child, family history, benign breast disease, alcohol use, exposure to radiation, oral contraceptive use and post menopausal estrogen replacement therapy, obesity and history of cancer in other breast.

They stressed the need for having a national registry on breast cancer and screening of patients to ensure detection of the disease at an early stage.

About treatment of the cancer, Dr Nehal said that it had come a long way from a very crude surgical method to very specialized surgical technique such as sentinel lymph node biopsy and breast reconstruction.

“Even more progress has been seen in the field of systemic therapy which includes cytotoxic chemotherapy, hormonal therapy and recently added targeted therapy,” he said, adding that breast cancer cure had been a success story partly due to easy diagnosis and partly due to improvement in the adjuvant chemotherapy.

Unfortunately in Pakistan there were financial limitations of the patient that restricted the use of modern therapies and drugs, he concluded.