EVERY October, breast cancer awareness month is observed in many countries to help inform people about the signs, symptoms and possible treatment of this fatal disease. According to WHO, about 1.38 million new cases are detected and about 458,000 die from breast cancer annually. Pakistan has a fairly large share of breast cancer patients with a younger patient population; every year, about 95,000 new cases are diagnosed, with most proving fatal.
The number of breast cancer-related casualties can be reduced with timely treatment and, therefore, emphasis on early detection is growing. But other interventions are also needed to ease the lives of the patients and support them through the agonising journey of diagnosis and treatment. These simple interventions can have a significant impact in low-income countries where social support is minimal and the poor cannot afford expensive cancer treatment.
Women experience multiple socioeconomic and geographical challenges. These play a central role when it comes to women’s health; in particular, seeking treatment for life-threatening diseases such as breast cancer. In low-income countries like Pakistan, gender discrimination is widespread in social spheres, including in healthcare facilities. Along with poor health literacy, there are accessibility and affordability concerns. These challenges intersect and create an adverse social environment for women suffering from breast cancer.
Socioeconomic barriers determine breast cancer patients’ fate.
Barriers to information are a central feature in late detection; knowledge not only helps in assessing the situation but also determines an individual’s health-seeking behaviour. Pakistani women have been found to be lacking in basic knowledge about self-examination as well as the signs, symptoms and risk factors of breast cancer, particularly women living in rural and underprivileged areas with low literacy and limited exposure to the world.
Misconceptions and ignorance about fatal diseases also affect survivorship. For example, in a study conducted with cancer patients undergoing treatment in New Delhi, the majority of patients believed their illness was a result of being cursed or a punishment for past sins. Such misconceptions have a hugely negative impact as they prevent people from seeking timely treatment.
Geographical barriers are also a key issue. The location of a health facility greatly influences a person’s health-seeking behaviour, but quality health facilities are non-existent at the grass-roots level and there are only a few hospitals offering treatments for cancer. These too are only in big cities, leaving vast swathes of Pakistan’s population in rural areas with limited resources to survive. Even common models for detection, such as clinical breast cancer examination or mammography facilities, are not available in remote areas. Inappropriate and inadequate transportation makes it even harder for rural and marginalised women to access specialised hospitals.
Those who succeed in tackling knowledge and geographical barriers are often affected by another strong hurdle — the expense of cancer treatment — which further exacerbates the situation. Accessing specialised hospitals located at a significant distance is problematic enough, but for people engaged in humble livelihoods that barely cover the cost of survival let alone accessing healthcare, lack of affordability is a major issue. Social support is almost non-existent, which further discourages families from seeking and/or initiating treatment they cannot afford.
These socioeconomic and geographical barriers determine cancer patients’ fate. Unfortunately, a large chunk of Pakistan’s population lives in remote areas with limited economic resources and literacy. Poor families of breast cancer patients are reluctant to make long journeys and carry out expensive treatment procedures. In this way, marginalised women are likely to miss out on early diagnosis and treatment. This is why interventions are not needed in one but several areas to facilitate women’s health.
Survival from breast cancer is possible if it is diagnosed early, since treatment then involves fewer complications. Early detection is doubtless the key to a cure. Therefore, training health workers in rural areas to recognise early signs and symptoms, as well as to impart and encourage breast self-examination among women, is of core importance. Health literacy is also central; women should be aware that seemingly harmless, painless breast lumps are more likely to be cancerous.
Along with creating mass awareness, women should be facilitated with routine mammography in order to have well-timed diagnosis of breast cancer. Linking hospitals in district headquarters with specialised cancer hospitals can also be fruitful as the former are within more people’s reach. Provision of health insurance for breast cancer patients can also have a significant impact in Pakistan, where poverty has constrained women’s lives.
The writer has a doctorate degree in women’s studies.
Published in Dawn, October 2nd, 2019