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Review of breast cancer risks in Pakistan

According to Union for International Cancer Control (UICC), 8.2 million die of cancer per year worldwide, while 14 million new cancer cases are registered every year. However, breast cancer is the top malignancy in Pakistan. According to data registry, the top three malignancies in all age groups and both sexes combined were breast cancer, leukemia and lip and oral cavity cancer.

40,000 women died of breast cancer in the country during 2017. About 90,000 cases of breast cancer were reported during the same year. Genetic disposition along with environmental factors, mainly linked to lifestyle, has presently exposed one out of every 8 to 9 woman in Pakistan at risk to be inflicted with breast cancer.

Pakistan was in list of the countries, wherein the rate of cancer patients was on the rise. The incidence of breast cancer was alarmingly high in Karachi. Patients in Algeria are abandoned due to hair and breast loss by their husbands and families as the amount of acceptance after the treatment is very low. Some females won’t even discuss about their diagnosis and would want to keep it a secret as they are scared they will be abandoned.

Pakistan observing World Cancer Day 2018, with the theme “We Can, I can,” also registered to have a comparatively high incidence of breast cancer induced deaths due to late diagnosis and delayed referral to appropriate facilities. Considering that over 60 percent of the total population of Pakistan lives in rural areas, the chances of a common man having knowledge about cancer and its risk factors are very bleak.

In Pakistan, the number of people diagnosed with cancer each year is increasing. A cancer mortality rate of 100,000 is itself proof of the devastated state of public health facilities. Being from low-middle income country, we don’t have many resources to treat such a huge number of cancer patients.

According to International Atomic Energy Agency cancer assessment mission report (IAEA) dated 4th Feb 2016, 150,000 new cases of cancer are emerging in Pakistan every year which were 140,000 in 2015 as per the Ministry of National Health Services, Regulations and Coordination (NHSRC) figures.

From 1990 to 2016, the cancer mortality rate in Pakistan actually increased. As a UN member, Pakistan has agreed to reduce premature deaths from cancer by 33 percent by 2013 as part of the sustainable development goals (SDG). This kind of target seems a bit unrealistic to achieve considering present facts & figures. To achieve it, we need strong engagement from everyone from healthcare professionals to common men.

To establish a national cancer action plan for prevention and control, in 2015 NHSRC launched the national cancer registry programs in major private and public hospitals through Pakistan Medical Research Council (PMRC). The purpose of cancer registry program was to gather data regarding “all-cancer” types and demographic of the neoplasms so that our health systems can be tailored.

Even if you live in the city, you might not be aware of what causes this disease and preventive measures.

This is in a scenario when Union for International Cancer Control(UICC) with the aim of supporting the World Cancer Declaration goals written in 2008 is trying to bring together people from across the world to ensure optimal awareness and significantly reduce incidence of cancer itself as well associated deaths by 2020.

Diagnosing cancer is not always easy; not all cancers show early signs and symptoms and other warning signs appear quite late when cancer is already advanced.

Generally there are similar types of symptoms in men, the most common being smoking followed by drinking alcohol. Many cancers take places because of these two unhealthy activities. Mouth and throat cancer also occur due to these activities.

Breast cancer is very common amongst females for a number of reasons; Women who don’t feed milk to their young born, or whose maturity starts before age and those who have history of cancer in their family or those who have had hormone treatment are at a risk of having breast cancer. The top three malignancies amongst adult females were breast cancer, ovary and uterine adnexa, and lip and oral cavity. Whereas in adult males, they were lip and oral cavity, liver and intra-hepatic bile duct lung and prostate.


Prevention measures

To avoid cancer, it is very important to lead a healthy life both for men and women. It is most important to avoid unhealthy habits like smoking, drinking alcohol, use of ‘gutka’ or ‘chaalia’, unhealthy food, lack of exercise, concern about the right weight and so on. It is recommended walking 10,000 steps per day as sitting on a chair for long intervals of time can be risky. It is recommended to walk every now and then especially in an office job.

Diet should be healthy and balanced; avoid eating a lot of meat as it causes intestine cancer. By leading a healthy life style, one can avoid the risk to cancer to a great extent.

Those who have a family history of cancer should have a regular screening. Women around the age of forty (40) should undergo Mammogram and ultrasound tests.

At the age of fifty (50), both male and female take Colonoscopy tests to know about intestine cancer. Those with a strong history of smoking should have CT scan once a year.

Being overweight or obese increases the risk of ten (10) cancers namely; bowel, breast, uterine, ovarian, pancreatic, esophagus, kidney, liver, advances prostate and gallbladder cancers.

Individuals can lessen the risk of getting diagnosed with cancer by avoiding tobacco, alcohol consumption and maintaining a generally healthy lifestyle, including a healthy diet and proper physical activity.

It is important to get regular medical check-ups done and to be aware and spread word about the symptoms that could indicate a cancer scare.

A seasoned oncologist warning that every woman is at risk to be inflicted with the ailment as compared to men said those with family history must be extremely cautious.

Urging women not to resort to hormone replacement therapy (HRT) at the onset of menopause and later, she said hormonal changes in the body is a pre-cursor right from the age of puberty to later stage.

Ageing was said to be a risk in itself with one out of every 1000 woman celebrating her 40th birthday; five out every 1000 woman attaining 50 years of age; 10 out of every 1000 reaching the age of 60 year and 16 of every 1000 women age 70 can be inflicted with breast cancer.

Early onset of menstruation and delayed menopause were said to be peculiar factors enhancing chances of the particular ailment among women. People in general and those who may have managed to win their battle against cancer need to extend emotional support to the ones fighting against cancer by sharing their own stories of surviving the life-threatening condition.

With specific reference to breast cancer, the disease is largely preventable through a healthy and active lifestyle with due attention towards weight control.

“Breast feeding is a natural mode to prevent the ailment often construed to be terminal,” said Dr Sana in reply to a question confirming that late deliveries and conceiving babies after 32 years enhance risk to breast cancer. There is no vaccine to prevent the ailment, however, culture to promote self examination among attaining age of puberty and mandatory mammography on annual basis at age of 40 plus can help avert associated risks.

Timely diagnosis was said to not only protect women from unwarranted pain and trauma associated with the disease caused due to malignant cells but also significantly reduce the treatment expenses. We Pakistanis need to be more vigilant and proactive about non-communicable diseases (NCDs) like cancer.

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