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The ‘C’ word

October 21, 2018

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BREAST cancer is the most common form of cancer and the second leading cause of cancer-related deaths among women. Although recent breakthroughs in research and latest advances in screening and treatment have dramatically increased survival rates, accessing these treatments and screening is still a challenge for many, particularly in low-income countries and rural and remote areas.

Pakistan has the highest rate of breast cancer in Asia; 40,000 women die of this disease and 90,000 cases are diagnosed every year. Every eighth woman in Pakistan is at risk of developing breast cancer.

October is referred to as breast cancer awareness month. While raising awareness about precautions and symptoms is an effective tool to prevent being afflicted with this disease and encourage early diagnosis, accessing treatment and screening facilities remains a problem. Factors such as poverty, illiteracy and ignorance lead to delays in diagnosis and treatment. Geo­graphical and sociocultural barriers exacerbate the situation. These include proximity to tertiary-level hospitals, socioeconomic conditions, cultural norms and how symptoms of cancer are perceived. Acknowledging and addressing these barriers and introducing a national-level breast cancer programme can have phenomenal results.

October is breast cancer awareness month.

Recently, I came across stories of breast cancer patients and survivors as part of a research study. These women belonged to rural Sindh and their lives were marked by poverty and a low socioeconomic status. Sociocultural and geographical barriers had further worsened their plight. With limited or no literacy and little exposure to media, they ignored the initial signs of breast cancer. There was no concept of self-examination and they could not recognise the symptoms for what they were. As a result, they did not seek treatment for several months.

Given their circumstances, appropriate medical treatment was extremely difficult to come by. Some of them were taken to the doctor only when the pain in the lump became unbearable. In rural and remote areas, the first point of ‘medical’ contact is often an atai or quack. These fake ‘doctors’, usually male, do not have sufficient knowledge about the problem and consider any lymph or cyst a normal occurrence and treat it with antibiotics or painkillers. This results in further delay and a worsening of the patient’s symptoms. It is only when her condition does not improve that the family looks for an appropriate doctor.

Surviving breast cancer is possible with early detection, but these women lived far from tertiary-level hospitals that provide screening, treatment and awareness about cancer. Their access to diagnostic facilities was influenced by sociocultural norms.

A woman’s mobility in rural areas is next to impossible unless she is accompanied by an appropriate male relative. A man in the family, usually the husband, will take his wife to the treatment facility; that is conditional upon his availability, willingness, how he perceives the woman’s condition and whether or not he is able to afford the expense. Thus, the majority of such cases of breast cancer remain invisible.

The battle of the cancer patients whom I met was multidimensional; along with fighting the disease and coping with the effects of chemotherapy, they had to confront the stigma associated with breast cancer. Particularly in less developed areas, breast cancer is seen as a curse or punishment that deprives a woman of her feminine beauty and inflicts death. Relatives and community members thus do not have much to offer the patient by way of support; rather, they are responsible for increasing her agony.

It is, therefore, crucial to focus on multiple areas such as problems with diagnosis, family support mechanisms and how communities perceive women’s health issues, particularly those related to women’s private parts. Raising awareness is a must, but families must also be counselled on how to deal with the suffering of a family member. Breast cancer is not only a woman’s illness; it affects the spouse as well. Together, both husband and wife experience disruption on personal and household levels, including the financial consequences.

The needs of breast cancer patients are complex. The psychological, social and cultural impact of the disease creates the need for family and emotional support, particularly during treatment. Families with requisite awareness counselling and trained health personnel are invaluable at such times. Studies have shown that support networks can have a positive effect on cancer patients’ mental health.

Forming support networks on local levels will also ease lives of patients and help them cope with stress and trauma. Women battling breast cancer can only fight well if there are avenues and people to support and encourage them. These networks can guarantee women’s well-being by ensuring positive health outcomes.

The writer has a PhD in women’s studies.

Twitter: @AghaNadia

Published in Dawn, October 21st , 2018