LAHORE: ‘F’ is lying in pain in one of Mayo Hospital’s wards. A patient of breast cancer, she has been admitted for surgery, but her lump is the size of a football now, and chances of her winning the battle seem improbable.

“She only came here because the lump had begun to tear through the skin, and the infection had begun to seep. It was stinking,” says a doctor.

The situation in Pakistan – which has the highest rates of breast cancer in Asia – is dire. Data collected by Pink Ribbon, a local non-governmental organisation (NGO) dealing with the issue, shows that cases of breast cancer rise by around 12 to 13 per cent every year and 40,000 women die of this disease. Also, one out of every nine women is at the risk of breast cancer, which translates to a startling 9.8 million women. In total, 90,000 new cases are reported every year.

But Dr Asghar Naqi, professor of surgery at the King Edwards Medical University, says the reasons for such high death toll and number of cases can be addressed.

“The first problem is ignorance,” he said. “The very first presentation – appearance in front of doctor -- of 90pc of breast cancer cases happen when the disease has reached stage 3.”

“In other countries too, there are delays but usually those delays are in system such as diagnosis or test results. In Pakistan, the patient does not see a doctor only because anything to do with the breast is a taboo. Then if they do go for treatment, many of them look for an easy way out,” he added.

The second problem is pirs or faith healers. ‘F’, for example, has tried many treatments, including faith healing (pirs) and homeopathy. And of course, there have been no results.

Forty-year-old Kausar, who discovered a lump a year ago, was actively discouraged by her family from visiting the doctor. Instead she was taken to a woman faith healer who whiled away time on the pretext of doing ‘spiritual magic’ to get rid of the lump. As its size grew and Kausar realised the ‘magic’ wasn’t working, she went to a doctor only to find out the cancer had grown too big. Ultimately, a breast had to be removed.

The most common discovery happens by accident. “Usually when most women notice a lump, it is around 3cm or a little more. But this size usually indicates stage 2 cancer,” says Dr Naqi.

This points at basic lack of awareness among women. Dr Naqi points out that unfortunately since pain is not a symptom the lump is not given importance. “In other parts of the world, mammography has come up as the most successful method to prevent breast cancer. In fact, prevention is the best cure. We must be able to detect a lump when it is just the size of a seed.”

The third problem, he says, is that many people do not have access to a proper healthcare centre. A majority of families cannot reach hospitals because of lack of finances or there aren’t any such facilities, or sometimes because a female doctor is preferred and is not available.

The doctor may ask the patient to get a needle biopsy done in order to check whether the lump is actually cancer or not. As a rule though, all lumps must be treated as malignant, not benign, Dr Naqi added.

A patient told her gynaecologist about with a lump, who began treating it for other diseases. Eventually, the patient succumbed to breast cancer. Her family did not know about the lump until much later.

Meanwhile, Pink Ribbon representatives say they are trying to raise funds for the construction of a dedicated breast cancer hospital in Lahore. “It will provide international standard facilities for diagnosis and treatment,” said a representative. “We aim for this to be free.”

For most people, breast cancer treatment is expensive. Almost every stage, especially chemotherapy, costs so much money that the patient may never receive treatment.

With the exception of a couple, most government hospitals do not have mammography machines. Yet, the best possible alternative, not just for NGOs, but also for the government’s health department, is awareness of the disease in both cities and remote areas as being integral to saving lives of thousands of women.

Published in Dawn, October 10th, 2017