Breast cancer patients are not getting due attention at two of Karachi’s biggest hospitals
According to the data made available by the Cancer Research Foundation of Pakistan, the incidence of breast carcinoma (cancer) is 35 per cent of all carcinomas of women, 70 per cent of these are pre-menopausal with highest incidence between the years 35-45 years of age. Thus, over the last decade, breast carcinomas have increased strikingly.
Another study by Dr Sarfaraz Niazi demonstrates a perturbing status. Since studies have indicated that breast cancer appertains to total calorie intake. And since the use of hormone in cattle milk production contaminates diary products, consumers are inadvertently getting an enormous dose of those hormones.
In another study, proffered at the European Society for Medical Oncology in October 2002, it was ascertained that breast cancer treatment and survival rates in developing countries rely greatly on a woman’s socio-economic status.
In Pakistan, researchers discovered that those from higher income families generally obtain adequate treatment and have favourable chances of surviving breast cancer, while indigent women often do not seek treatment out of apprehension of physical/emotional repercussions from the families, inept guidance from local doctors or some auxiliary factors.
A study conducted by Dr Zeba Aziz of Allama Iqbal Medical College, Lahore, which involved 286 Pakistani women with the breast malignancy, demonstrated the following inference.
Among the women from higher income families, nearly 75 per cent were diagnosed with early stage breast carcinoma and 89 per cent received sufficient treatment for their disease after 10 years. A full 73 per cent of these women were still alive.
By comparison 50 per cent of the women from poor families were diagnosed with advanced breast cancer; only 44 per cent received sufficient treatment as a denouement, 49 per cent of women of middle-income families and 22 per cent of women from low income families were still living 10 years later.
So what facilities are offered to the middle and low-income women of the metropolitan city of Karachi?
The Civil Hospital has six departments of surgery. Each department has its OPD once a week. Unfortunately, no breast clinic is held in the hospital. Patients with breast complaints proceed to any surgical OPD and receive medical care.
Currently, there is one female chief of surgery at CHK and hence most breast cases approach her. Dr Naheed Sultan, head of surgical ward realizes the acute need for specialist breast treatment clinic and aspires to start one in her department. About 50 such cases every month get admitted to the unit and nearly 50 patients per month get admitted to other five units.
When a female patient arrives with a complaint, she is given a physical examination in the OPD, after which if required, she is admitted to the ward. After the preliminary workup in the ward, the need for a mammogram arises. The patient has to get it done from outside the hospital — sometimes paying as much as Rs2000 to Rs2500! Compare this to a price of Rs250 — Rs300, which would be the cost of a mammogram if done from within CHK.
The only mammogram machine of Civil has been out of order for the past two years. The result has been that so far, an estimated 2400 patients have been denied treatment at CHK.
After having a mammogram done, the patient may require FNAC, fine needle aspiration, which costs between Rs300 to Rs500. The (U/S) ultrasound costs Rs60. A whole MR Mastectomy costs upto Rs2000 — Rs2500 at CHK.
About 70 per cent of the occurrence coming to this surgical department of CHK are benign and 30 per cent malignant according to the doctor.
The nurses of general surgery are not trained as a breast caring nurse, which is a separate field altogether. A breast casing nurse is one who is trained to do the physical examination of breast patients, then take them for a mammogram and also provide a psychologically supportive environment.
So, what would be required to open up a breast clinic at CHK? A separate room, a trained nurse, one RMO willing to work in this field, and yes, a functional mammogram machine.
JPMC is another mammoth hospital catering to the needs of the destitute. It has three surgical units and hence such cases head to all three wards. In the JPMC, only Ward II holds a breast clinic. This clinic commenced on May 2002 — and is still in its infancy.
Dr Salim Soomro, a general surgeon is running the clinic. Initially, there were few patients as women were diffident in showing themselves to a male physician. But now the clinic caters to about 40 patients per OPD.
The OPD is held twice a week. Mammography costs Rs300; ultrasound costs Rs25, FNAC costs Rs50 and the histopathology report is for free. Oncologist consultation is free as well. From admission to tests, to a major breast surgery, the final payable amount comes to approximately Rs1100.
This clinic comprises of a consultant, one post graduate and one breast caring nurse. There is day care surgery facility where the benign cases are operated upon. Most common post-operative complications found in public sector hospitals are
* Wound infections;
* Serum of formation.
In past year and a half, the cases that received treatment at JPMC Surgery II breast clinic include: tuberculosis breast 20 patients male gynocomastia, 16 patients; cancer in male breast, 3 patients and others 257 patients.
Facilities, if provided, would give maximum consideration to this malady.
* Proper diagnostic facility;
* A surgeon;
* Consultant medical oncologist;
* Counsellor to provide psychological support to the patient
* Breast care nurse.
Since the prevalence of this ailment is waxing, breast screening programme is becoming an even more useful tool. In some countries mammo-buses have started visiting remote areas, carrying mammogram machines, a trained doctor and a nurse.
We have to understand the relationship between our less privileged class and nature in context of environmental charge, disease ecology, their economic limitation and social dilemmas. It is only through this process that we will be able to identify the determinants, consequences and dynamics of the problem and learn to plan, implement and evaluate health promotion and disease prevention strategies.
If our public sector hospitals resolve to cater to the basic needs of different dynamics of a disease, then they can provide timely treatment and perhaps endorse the spread of awareness amongst the general public.
But then is it even conceivable in an environment so lackadaisical where the only mammogram machine has been out of order for the past two years? The change of the medical superintendent of Civil Hospital may bring some change.
Every detection can save your breast and your life. Breast cancer is the commonest form of cancer among women. If detected early, it is curable. But if discovered late, breast cancer will kill. Who is likely to get breast cancer?
* Breast CA is more common in women;
* Often occurs b/w ages of 45 and 55;
* Individual who have already had cancer in one breast; or sister, fallen prey to this malady;
* Who have never been pregnant or those who had their first child after the age of 30;
* Women who began menstruating at a young age; or have had a late menopause.
WARNING SIGNS
* A painless lump in the breast or armpit is the commonest sign;
* A persistent rash around the nipple;
* Swollen and thickened skin around nipple;
* Dimpling of skin of breast;
* Puckered skin over the breast; * Bleeding or any unusual discharge from the nipple;
* The nipple pulled back instead of protruding.
Breast Self Examination (BSE) is simple and could result in early detection of cancer. BSE should be done once a month; about a week after the commencement of each menstrual period. For women who do not have periods, a fixed date of each month can be chosen on which the BSE could be carried out. Women over 40 years of age should see their doctor once a year for a breast examination.
Breast cancer patients are not getting due attention at two of Karachi’s biggest hospitals 
