Dr Humera Mahmood Consultant Oncologist Head of Clinical & Radiation Oncology departments Atomic Energy Cancer Hospital NORI Islamabad
Atomic Energy Cancer Hospital NORI Islamabad, one of the 19 cancer hospitals working under Pakistan Atomic Energy Commission, has recently been declared as IAEA anchor centre for providing teaching and training to the medical professionals in the fields of Radiation Oncology, Nuclear Medicine and Diagnostic Radiology. The institute has always been in forefront for raising awareness about breast cancer. A series of activities are organised throughout the year and more so in the month of October so as to convey the facts about breast cancer and to alleviate myths and misperceptions about the disease.
The building of the hospital is illuminated pink; screening and consultation services are provided throughout the month by dedicated team of doctors.
Dedicated reception desk is provided for entertaining women coming for breast cancer screening. For convenience, consultation, examination and mammograms are done the same day.
Education material is made available in the form of brochures and posters with different kinds of information related to prevention, diagnosis, and treatment of breast cancer. Different souvenirs depicting awareness messages are also made available. Breast self examination technique, an important component of screening is also available in the form of brochure. All the information is available in simple language.
Oncologists from NORI deliver cancer awareness lectures every now and then in different forums including schools, colleges, universities and within the premises of the hospital as well. Each time the halls are jam packed and there is so much enthusiasm in the participants who are eager to be made aware of the deadly disease.
Cancer survivors share their experiences in fighting the disease and thus help in motivating women to get themselves screened, diagnosed and treated.
NORI Patients Support Group launched in 2017, from the platform of the hospital and comprising of treated and cured patients is playing an important role in helping newly diagnosed women overcome their apprehension regarding pros and cons of treatment, expected survival, cost of treatment etc.
To keep the doctors abreast of the advances in the field of cancer diagnosis and treatment, educational seminars and symposia are also organised.
Cancer awareness walks involving doctors, nurses, paramedics, patients and their relatives, medical and non medical students, social workers are also held at the end of each program in the hospital.
Print and electronic media are also being used to spread the message far and wide as limited number of participants can be accommodated in physical programs.
Cancer awareness Webinars are also being held for the audience who are unable to attend physically.
Facts about breast cancer:
Though cancer can affect any part of the body, but breast cancer is more often talked about and the whole month of October is dedicated for its awareness not only because it is the commonest cancer constituting more than 40% of all female cancers but also because it is affecting our female population who as mothers, daughters, sisters and wives play central roles in their families.
Breast cancer is not only treatable but can be cured as well if detected at an early stage.
Moreover it is one of the preventable cancers as well by modification of lifestyle and dietary habits. Daily exercise and intake of fresh fruits and vegetables give protection against numerous cancers.
In South Asia Pakistan has the highest incidence of breast cancer. It is more likely due to sedentary lifestyle, Intake of oily foods and obesity. Other possible risk factors include increasing age, positive family history of cancer, smoking, alcohol, exposure to increased oestrogen due to early menarche, late menopause, hormone replacement therapy. Lack of breast feeding and no childbirth or childbirth in late age also increase the risk of falling prey to breast cancer.
Diabetes is also one of the predisposing factors.
Presence of cancer in any parent’s family can increase the risk of breast cancer. It’s not just the mother who is to be blamed.
The risk increases further if one of the responsible gene mutations is present in the family members though the prevalence of hereditary breast cancer is 10-15%. BRCA1 and BRCA2 are the two most notorious genes, if mutated increase the risk of breast cancer upto more than 90%. Gene testing should be available in the country at nominal charges otherwise most of the women can’t afford it.
Prevention is always better and cheaper than cure. Whereas primary prevention is possible by modification of lifestyle and dietary habits, secondary prevention is done by screening.
Breast cancer screening is done by breast self-examination, clinical breast examination and mammograms.
Breast self examination is recommended to be started from the age of 20 and can be done monthly without going anywhere and no equipment is required. It hardly takes 5 minutes.
Clinical breast examination (by the doctor) and mammograms are recommended once in a year after the age of 40 . After the age of 70 years, the frequency is determined by the risk involved in a particular female.
Be cautious:
For early detection of breast cancer, one should not ignore the symptoms including lump in breast, any discharge from the nipple specially blood stained, any ulceration or discoloration of skin, nipple, or skin retraction. In case of any of these symptoms, do seek medical attention. Though about 50% of the swellings can be benign but to confirm its nature, one needs to consult the doctor and appropriate tests will be required.
Men can also suffer from breast cancer though prevalence of male breast cancer is less than 1%. Whereas Pink color is dedicated for raising awareness of female breast cancer, blue color symbolizes male breast cancer. According to an estimate, one out of every thousand men can become victim of breast cancer. Presentation, diagnosis and treatment of male breast cancer is the same as of female disease but due to lack of awareness men also present late.
Besides lack of awareness on the part of patients and their relatives, other causes of late presentation include lack of knowledge of general practitioners and other treating physicians, poverty, cultural taboos and cultural conservatism, and lack of infrastructure in rural and farflung areas.
Advantages of early detection: The smaller is the tumor, the greater are the chances of cure. In stage I and II, 05 year survival is more than 90% and it drops to 20% in stage IV.
Besides health benefits, there are also indirect economic benefits as there’s shorter duration of treatment and lesser expenditure in early stage of the disease. The patients are less likely to become handicapped and can restart their job and home chores after completion of treatment.
Treatment modalities: More than 90% of breast cancer patients need to be treated with suitable combination of surgery, chemotherapy, hormonal therapy, targeted therapy, and radiotherapy. One of the main advantages of early detection is conservation of breast instead of removing the whole of it.
Chemotherapy is the use of cytotoxic drugs given in the form of cycles by qualified and trained nurses. The commonest concern with this treatment modality is the loss of hair but hair does regrow in all the patients within 6 months of completion of treatment.
Radiotherapy is the treatment of cancer using ionizing radiation with the help of specialized equipment in dedicated hospitals under supervision of qualified doctors, medical Physicists, and radiotherapy technologists.
Seventy to 80% of cancer patients in the country are catered for in PAEC cancer hospitals equipped with both diagnostic and treatment facilities.
Atomic Energy Cancer Hospital NORI has all the latest state of the art diagnostic and treatment services under one roof including linear accelerators, cyberknife, CT and MR simulators, digital mammography with tomosynthesis and stereotactic biopsy, PET CT besides indoor and outdoor services.
Suggestions for improving awareness in masses and detection of breast cancer in early stage:
There’s dire need for a national breast cancer screening program in the country.
There should be dedicated breast clinics in all the public and private sector hospitals so as to help women get themselves screened without any hesitation.
Lady health visitors should be trained in breast examination and then they can play their role in farflung areas and can also distribute education material.
Awareness programs should be organized for GPs and doctors working in BHUs and RHCs.
Gynecologists should make a habit of doing clinical breast examination in their patients.
