Catching it early

By Zubeida Mustafa

55-05-06-1991

‘A’ has breast cancer. A few years ago this diagnosis would have amounted to sounding the death knell for her. Not so today. Doctors give ‘A’ an excellent prognosis, the very high rate of mortality from this disease notwithstanding.

‘A’ stands a good chance of survival because her cancer was discovered at a very early stage. In fact, when surgery was performed on her, the tumour in her breast was not even palpable — that is it could not be felt.

Now ‘A”s surgeon, Dr Shaista Khan of the Aga Khan University Hospital, Karachi, is optimistic that the disease has been checked since it was confined to the breast cells and had not spread.

It was a mammogramme (an Xray of the breast) taken during a routine examination that showed up the malignant lesion, making diagnosis possible.

What was extraordinary about ‘A’s’ case was the overly cooperative and understanding approach of her husband, who virtually pushed her into being screened for breast cancer. “Normally not all husbands have that attitude,” says Dr Shaista Khan.

Her observation is that a complicating factor in breast cancer is the women’s fear of losing their breasts.

“They would rather lose their life,” she adds. And this is a phenomenon common to Europe, America as well as Pakistan. “In our society, I can understand this attitude,” Dr Shaista says. “It is widely presumed that a woman, who loses her breast loses her husband’s affection too. It could be seen providing him as a valid justification for remarrying!”

Now technology offers new hopes for breast cancer victims. Mammography, if used judiciously, could save their lives as well as their breasts.

Mammography is like any other X-ray. It is slightly uncomfortable, though not as painful as made out by radiologists and doctors.

“When the cancerous tumour is very tiny only a mammogramme can pick it up. That is when we can spare women the trauma of mutilation,” Dr Shaista says.

“I would want to detect cancer even before a lump is formed,” she adds.

Moreover new reconstruction techniques, which involve the transfer ‘of tissues from the abdomen or the back to give an extra mound to the removed breast area, have revolutionised the treatment of breast cancer.

Now not all patients need to undergo mastectomy and the resultant disfiguring which inhibits so many of them from having themselves screened for breast cancer.

The reconstruction job can be neatly done by a surgeon with the necessary expertise. One of Dr Shaista’s patients whom I met just has a scar across the left side as a vivid reminder of her mastectomy.

t 35,’B’ is understandably conscious of her figure and appearance. Dr Shaista’s artistic and surgical skills have ensured that when ‘B’ is up and about, it would be impossible to make out that she is different from other women in any way.

Dr Shaista Khan very emphatically speaks of the need to create awareness in women about breast cancer through public education. Early detection is the key to the successful management of cancer. “I wouldn’t use the word ‘cure’,” she says. “Breast cancer can recur even after 20 years. What we aim at is to keep the patient disease-free for the maximum period.” This is possible only if the onset of the disease is detected at a very early stage and the offending cells removed. Hence the over-emphasis on self-examination.

Dr Shaista insists that all girls should be taught the technique of self-examination which can help them detect a lump in the breast as soon as it is palpable. Girls colleges could take the lead in this.

But after the age of 40 Dr Shaista suggests a routine of self-examination for 11 months followed by a, clinical examination in the twelfth month.

She also recommends a mammography every second year if no extraordinary risk factors are present.

Dr Shaista is pleased that in the four years that she has been conducting the Breast Clinic at the AKUH she has found a growing awareness among women of this disease.

But it is not enough. Only 15 per cent of the women come for a checkup with no specific symptoms — invariably because they have seen a friend, relative or neighbour come down with breast cancer. The majority of them come to consult a doctor because they are suffering from pain in the breasts.

“If we could somehow institute a routine screening mechanism, and educate and motivate our women to cooperate, the mortality rate of breast cancer can be cut down drastically,” Dr Shaista says.

What is more important, this has to be a continuing process. A; woman can get breast cancer at any time. “This is not generally realised and a woman who gets a clean chit is inclined to become complacent about her check-ups. Hence the attendance of healthy women for follow up visits at the Breast Clinic tends to fall,” Dr Shaista observes.

At present 15-20 per cent of those who attend the AKUH Breast Clinic are diagnosed as having cancer. If there were greater awareness, this ratio would be lower.

But I feel that a mammography might not be very cost-effective for use in a general screening programme. Costing anything in the range of Rs 400 to Rs 1000, a mammogramme is not really affordable by most women. Dr Shaista insists that at least those women above 40 who can spend on health should have a mammogramme done every two years.

Dr Yunus Shaikh, the radiologist at AKUH, explaining the high cost of mammography says that a mammography unit is not an all-purpose X-ray machine. Furthermore the film used is a special one.

Given the high charges of a mammogramme and the low awar«ne«s of its importance, this device is not in general demand. There are only eight or so mammography units in the whole country.

One feels that it is therefore essential that mammography be introduced in the public sector health institutions where high risk patients from low income groups are provided facilities for breast Xrays at subsidised rates. Whether the costs are met by the government, from public donations or the Zakat Fund (as the Urology Institute at the Civil Hospital manages to do for its kidney transplantation and dialysis programmes), social justice demands that mammography be made available to as many women as possible, including the indigent ones. After all breast cancer can strike any one irrespective of her socio-economic status.

Source: Dawn, 05-06-1991