BREAST cancer, once thought to be the disease of affluent and developed world, is equally prevalent in the developing world. Its incidence is increasing at an alarming rate in the developing countries including Pakistan.
Changes in reproductive behaviour, modern lifestyle, and improvement in life expectancy are some of the factors associated with the rising numbers. The true picture, however, is difficult to ascertain due to limited research and data collection facilities in these countries.
Pakistan has the world’s highest reported incidence of breast cancer in reproductive age women; the incidence of breast cancer in women of all ages is reported to be the highest in Asia — 69.1 per 100,000 women. Every year more than 90,000 women are diagnosed with breast cancer and almost 40,000 of them die of the disease in Pakistan. The estimated population of Pakistan is 180 million, and more than half of these are women. About two-thirds of the population is below the age of 30.
The number of breast cancer patients in Pakistan is set to grow.
This highlights the importance of the breast cancer issue in Pakistan, where its incidence is expected to rise further as the women population grows older and life expectancy improves. Breast cancer, therefore, is expected to become a critical public health challenge for Pakistan that will affect the lives of hundred of thousands of women and their families.
Breast cancer, if diagnosed early, has a high cure rate and excellent prognosis. Thanks to medical advancements and dedicated care providers, nine out of 10 women are surviving beyond five years in the developed countries. The prognosis, however, is still very bleak for women in Pakistan where hardly four out of 10 survive up to five years. Majority are diagnosed when their disease has already progressed to an advanced stage.
This mainly results from delay in diagnosis or seeking medical help. Factors that constitute barriers to early detection include: lack of awareness, social stigma, cost of treatment, and lack of healthcare facilities and trained specialists. Also, in its advanced stages the disease results in a substantial financial burden for patients and their families as treatment at this stage often incurs a much higher cost compared to early stage breast cancer.
Recently, there has been commendable efforts by some non-profit and government organisations to raise breast cancer awareness. However, the country lacks organised breast cancer care and a national screening programme. In a rapidly advancing medical world, where cancer treatment is becoming complex and requires a multidisciplinary approach, Pakistan is lagging far behind.
The country has a severe shortage of trained breast cancer surgeons, oncologists, radiologists and other support staff. Specialist facilities are few and overwhelmed by the ever-increasing number of patients on waitlists seeking treatment. Rising costs of cancer drugs coupled with long-term follow-up consultations make it harder for the majority to continue their fight against the cancer.
With the increasing adoption of Western lifestyle habits — delayed marriages and child-bearing, lower parity, avoiding breast-feeding, and a sedentary lifestyle — women in Pakistan are expected to experience an increase in breast cancer incidence rates in the coming decades.
Population dynamics are also changing in the country. As mentioned earlier, two-thirds of the current population in Pakistan is below 30. This ratio, however, could reverse soon with the growth of population and improvement in life expectancy. What this means is that in the coming years, the number of breast cancer cases will see a huge increase in Pakistan.
Unprepared, the country will witness preventable deaths of thousands of disadvantaged women affected by the disease each year.
The issue, therefore, demands a well-directed cancer control programme focused on population screening, raising awareness, extending treatment facilities and training enough healthcare providers in the management of breast cancer. Establishing a central cancer registry for reliable data should also be prioritised. Specialised centres and experts could play a vital role, not only in the delivery of care and capacity building, but also in devising local and national policies and country-specific guidelines to effectively combat the disease.
An important task for the government will be to bring down the disproportionately high mortality rate due to delay in diagnosis or seeking medical help that result in advanced stage disease at presentation. Early detection can result in down staging of breast cancer, which is one of the most promising long-term strategies for preventing disease-related deaths. By building on existing infrastructure, utilising lower-cost health service options, such as community health workers, and engaging in partnerships with affected communities, there is great potential to reduce the burden of breast cancer in Pakistan.
The writer is a breast cancer surgeon.
Twitter: @TahirMohammd
Published in Dawn, February 28th, 2016
