Breast Cancer: Deadly but not so incurable

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Breast Cancer:
Deadly but not so incurable

Prof. Dr. Altaf Hussain Rathore

She was a young woman of 28 years, married since last one year. She presented with a swelling in the left breast she first noticed about six months back. Her breast was looking like classical Leonardo da Vinci painting, i.e. protuberant and smooth. But when I examined her it was hard like a brick. Her axilla was full. She had nodules in the skin below her breast. It was an advanced carcinoma of the breast. She came to me four months earlier when the swelling was small and I told her then that it was a cancer in curable stage, and that she should get it treated immediately. However, she disappeared for the next four months to be treated by faith-healers.

Prof. Dr. Altaf Hussain Rathore

A similar case of advanced breast cancer came before me one month back. She was a widow of 32 years and had cancer for the last two years. But she did not tell it to anyone or get it treated because of shyness and poverty. Such cases of advanced breast cancer have become almost everyday experience for the surgeons of Pakistan. Rich or poor, educated or otherwise, are equally likely to be involved in the neglect of such a life-threatening ailment. A modern-looking, highly educated professional woman of about 30 once came to me. Outwardly looking so fashionable and well-dressed, she presented with a big swelling in her left breast and armpit. The lumps had grown nasty and maggots were crawling out of them. How she reached this advanced stage of the breast cancer and did not get herself treated: because she was afraid of the surgeons whom she thought would cut off her breast—a symbol of feminine beauty she wanted to preserve at all cost. Her main concern was to remove her maggots. And I cannot forget a really sad scene when I was called to see a case of breast cancer a few years back. A young woman in her thirties was lying unconscious, almost gasping. She had a big ugly sore in her right breast smelling awfully, so much so it was it was difficult for a non-professional to stand in that room for a few moments due to stench. On the side of her bed her little boy of about three was very efficiently spraying air freshener perhaps thinking that her mother was sleeping and a good aroma will give her mother some comfort.
No doubt like any cancer breast cancer is fatal and is prevalent throughout the world. But it does not mean that there is no cure for it. Definitely there are so many advances in its treatment. Surgery is its mainstay. Radiotherapy, chemotherapy and immunotherapy are other options, separately or in combination. But they are effective only at an early stage, so-called the curable stage. That’s why it is staged according to the tumor size, its extension in the axilla and the whole body. The size up to 2.5 to 5 cm is generally considered curable.
Mind it, not every swelling in the breast is a cancer that needs removal of the whole breast. For that reason a special x-ray called mammogram is taken. This can also delineate the tumor if it is less than 1 cm which cannot be felt by human fingers. For double check one should also remove a piece of swelling, so-called biopsy, for examination in the laboratory to confirm the diagnosis. Lately, it has been replaced by FNAC (fine needle aspiration cytology) which means removal of material from the breast by a syringe and examining it in the laboratory for the malignant cells. Mammogram after physical examination and FNAC has become a universal protocol for any doubtful swelling in the breast before the final treatment.
Every case of the breast cancer is not so advanced, as I described earlier, which can cause death of the sufferer within a few months no matter what treatment we do. But percentage of the incurable cancer in Pakistan is one of the highest in the world. It is perhaps due to illiteracy, lack of health education, poverty, modesty and shyness, too much of religious consciousness, beauty-mindedness, quackery, belief in faith-healing or simply a careless attitude. There are more chances of survival if it is detected and treated at an early stage.
Internationally, breast cancer is divided into four stages depending on the size of tumor, involvement of the gland and their characteristics in armpit (axilla) and its roots (secondaries) in other parts of the body. First two stages are early which we call curable. For practical purposes, a lump in the breast less than 5 cm which is not fixed to the skin or deep muscles or causing ulcer or puckering or scarring of the skin or deformity of the breast or the nipple, is a curable disease. When the disease gets established, it starts progressing rapidly—in some cases in days and weeks.
Another question comes into mind: Is there any way by which we could prevent this deadly disease? Unfortunately, the answer is a ‘No’ except for an early diagnosis and treatment. So it is universally recommended that every woman above 35 years of age, especially the ones who are at high risk, should examine themselves regularly at least once in a month. This age is reduced to 20 years in Pakistan because breast cancer occurs at relatively younger age. The high risk cases include:

1. Persons with a family history of any type of cancer
2. Where mother or grandmother suffered from breast cancer
3. Women whose one breast had already been treated for cancer
4. Women with other factors such as obesity, smoking, late marriage and first pregnancy at a late age.

Another almost 100% sure prevention is the removal of both normal breasts (a currently celebrated Hollywood actress adapted because her mother died of breast cancer). I am not sure if any person will opt for this. The lesson: report to your doctor, or better a surgeon, as soon as you discover something unusual in your breast.
In Pakistan it is postulated that: 1) one is every nine woman is at risk of having breast cancer, 2) more women of younger age groups starting from 20 years are at risk of getting this disease compared with the West where breast cancer occurs mostly at a later age, 3) mortality of breast cancer in Pakistan is very high due to the late presentation. It is estimated that around 40,000 women die annually in Pakistan because of breast cancer. So there is a great need of health education for female population in Pakistan, especially about the awareness of this deadly yet curable disease.

(Note: The author is a retired Professor of Surgery, presently working as a consultant surgeon at Foundation Hospital, Rajana, District TT Singh. Email: This email address is being protected from spambots. You need JavaScript enabled to view it. )

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