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By Laaleen Khan

Breast Cancer in Pakistan

(Note from author: I am not a physician, so this piece should not be construed as medical advice or scientific fact.)

1 in 8 women has breast cancer in America.
1 in 22 women has breast cancer in India.
1 in 5 in women has breast cancer Pakistan.

Pakistani women have the highest rates of Breast Cancer among all Asian populations. They get the disease at a far younger age than women in Europe and the United States, often have larger lesions and are more prone to metastatic cancers.

In 2004, the Pink Ribbon Campaign in Pakistan discovered the following horrifying facts:

- Breast cancer is the most common cancer in Pakistani females, representing more than 1/3 of female cancers and about 1/4 of all malignancies.

- Approximately 35% of Pakistani women are likely to suffer from breast cancer at some point in their lives.

- More than 90,000 of the 1 million global cases of breast cancer are from Pakistan, and about 50% are from Punjab. About 10% of these women are diagnosed, but 75% do not seek treatment and die within five years.

- As a result, there are only 2,250 women in Pakistan who are treated for breast cancer out of 90,000 cases yearly, with 40,000 annual deaths!

In India, it’s the second most common type of cancer among women, particularly in urban areas. Studies suggest there are between 75,000-100,000 reported cases a year. The question remains, why is there such a wide disparity among breast cancer incidences between India and Pakistan (1 in 22 vs. 1 in 5 in women over 40) when our countries have a shared border and history, not to mention similarities in women’s ages during childbirth, marriage and various elements in our socio-cultural landscape?

I may not be a doctor, but I’m certainly not stupid.

Ignorance plays a big role in breast cancer diagnosis that’s too late to be effective. There are social taboos at work too. If you were to go for a routine mammogram, for instance, the receptionist of the radiology lab would gaze at you with pity, thinking you have a tumor rather than assuming you were a conscientious person getting a routine checkup (I’m speaking from experience). That’s the whole problem. There shouldn’t be something obviously wrong when you go—it ought to be a normal part of age-appropriate preventive care, just like annual gynecological and dental checkups.

Elsewhere in the world, particularly the United States and Europe, women are expected to get preventive care, such as mammograms and pap smears and no one bats an eyelid. Kylie Minogue, Sheryl Crowe, Cynthia Nixon, Christina Applegate and Anastacia have publicized their experiences with breast cancer and have become fund-raising advocates. After treatments, they’ve continued with their successful careers and made magazine covers. Such strong attitudes are inspirational. However, while Canadian-Indian Lisa Ray recently publicized her fight with multiple myeloma, other South Asian celebrities haven’t seemed to have followed her example.

In Pakistan, it’s often unheard of to get yourself checked unless you have a noticeably hard lump and are forced by family members to consult a doctor. Breast cancers often go undetected for so long that the majority of silent sufferers already have stage 3 or 4 cancer by the time they are diagnosed. In 2008, a mere 953 cases of breast cancer were recorded by Imran Khan’s Shaukat Khanum Memorial Cancer Hospital in Lahore (five of these cases were in men).

This is purely conjecture and, again, I am not a doctor, but Pakistan’s national pastime of carnivorous feasting couldn’t help. Even vegetable dishes on Pakistani menus invariably include an unhealthy dose of red meat: aloo gosht (potatoes and meat), anyone? Trying to find a vegetarian snack in a café is a challenge when chicken is virtually regarded as one.

When it comes to reproduction, marriage between first cousins is still a common practice here, too. It’s common knowledge that the highest reported rates in the world are among Ashkenazi Jews, who have a genetic mutation that has been reproduced via inter-marriages within their race. Maybe there’s a similar mechanism at work in Pakistan.

Also, many harmful pesticides and herbicides banned internationally are cheaply disposed of in developing countries and have been identified as human or animal carcinogens. One of my childhood memories from the 1980s is quizzically watching cheesy TV commercials for chemical pesticides and fertilizers, where kissans (Punjabi farmers) using their magical sona urea (a form of fertilizer) cheerfully danced bhangra while singing the merits of profit-reaping cheap pesticides (DDT) in lieu of natural (albeit smelly) cow manure.

Environmental pollution, too, plays a significant role, creating dioxin, one of the most toxic chemicals in the world and a breast carcinogen to boot. Dioxin is even found in human breast milk and passed onto infants before they’ve left the womb. There are other, more controversial ways to protect fetuses and these involve genetic testing and treatments via IVF in women carrying a breast cancer gene.

I have to admit, I’m somewhat skeptical when doctors use the term “survival” for cancer success rates. I used to think it meant a long, healthy lifetime instead of just five years.

When it comes down to it, it’s ignorance, fear and denial that are the real killers.

Laaleen Khan is a media entrepreneur and mother. Born and raised in Lahore, Pakistan, she spent her early childhood and collegiate years in the United States and is a resident of Islamabad.


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