Development of cancers is not a recent phenomenon. Humans and other animals have been contracting cancer throughout recorded history. This has been proven by fossilised bone tumours and ancient manuscripts. The word itself was coined by Greek physician Hippocrates who used terms carcinos and carcinoma to describe non-ulcer-forming and ulcer-forming tumours, respectively. However, the ever-increasing human population resulted in a hike in the prevalence of cancer.
In 2012, an estimated 8.2 million deaths from cancer occurred worldwide and 14.1 million new cases were reported. The four most common cancers occurring globally are lung, breast, bowel and prostate cancer which account for 4 in 10 of all cancers diagnosed and which have been amongst the most commonly diagnosed worldwide since 1975. It is also speculated that approximately 23.6 million new cases of cancer will be reported each year by 2030 collectively from all parts of the planet. Breast cancer is the most common invasive cancer in women, comprising a quarter of all cancers diagnosed in women in 2012. In 2008 alone, this type of cancer caused a total of 458,503 deaths all over the world.
90,000 cases of breast cancer are being annually reported in the country with over 40,000 deaths, bringing Pakistan at the top of the list of Asian countries in terms of rate of occurrence of breast cancer
Like every other visible type of cancer, breast cancer has also been described in ancient documents (in fact, it is the most often documented form of cancer!). Nevertheless, despite reports of its incidents, it was quite uncommon until the 19th century. This was not because our lifestyles were comparatively healthy but because of the fact that most women used to die too young to have developed breast cancer owing to frequent childbearing. Those who survived to middle age were imparted luck through the various medical merits that breastfeeding harbours for mothers.
The historical background of this deadly disease brings into limelight the key contributing factors that result in it. Nonetheless, despite the lethality of the disease, breast cancer was feared and discussed in hushed tones before the 20th century as if it were shameful. Consequently women suffered silently instead of seeking medical help. It’s awareness increased only when the possibility of successful treatment and long-term survival rates improved.
The breast cancer movement of the 80’s and 90’s and the Pink Ribbon campaign deserve credit in this regard. In fact, Pink Ribbon has become the most prominent symbol of breast cancer awareness and are most commonly seen in October which is observed as Breast Cancer Awareness Month in several countries, including the United States and Pakistan. The colour pink is held as a symbol of femininity thus it evokes solidarity with affected women, but it has been widely criticised for overlooking male breast cancer, a rare type that accounts for about one percent of all breast cancers. Keeping in view the occurrence and prevalence of this form of cancer, male breast cancer advocacy groups publicised the ‘pink and blue ribbon’ and globally established the third week of October as Male Breast Cancer Awareness Week.
The fixed risk factors are those caused by genetics and there is really nothing which can be done about them; the modifiable risk factors, however, are in one’s own hands and are associated with one’s lifestyle and environment. Gender (women are nearly 100 times more vulnerable to breast cancer than men), age (invasive cancer mostly occurs after the age of 55), race (Caucasian women are more prone than other races), family history, personal health history, menstrual and reproductive history (menstruation before 12, menopause after 55, having first child at an older age or never having given birth) and genomic mutations (switching on of oncogenes, BRCA1 and BRCA2,along with others, which can be determined by genetic tests) are major genetic factors, while having a sedentary lifestyle due to lack of physical activity, a diet high in saturated fats and lacking fruits and vegetables, being overweight or obese, frequent consumption of alcohol, smoking tobacco, lack of breastfeeding and/or childbearing, hormonal birth control, induced abortion, suffering from diabetes mellitus, exposure to light pollution and radiation, and combined hormone replacement therapy as prescribed for menopause are speculated to be leading environmental factors. Despite anything to the contrary, 60-70 percent of people with breast cancer have no connection to these risk factors at all, bringing assuagement to many.
Despite the lethality of the disease breast cancer was taboo and discussed in hushed tones before the 20th century as if it were shameful. Consequently women suffered silently instead of seeking medical help
The next concerning point is its early detection and timely diagnosis, the latter being entirely dependent on the former. According to the Johns Hopkins Medical Centre, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important”. Looking for unusual tenderness, lump or thickening, change in texture, enlargement of pores in the skin, dimpling, swelling, shrinkage, asymmetry, inversion, development of scales, ridges or pits, or any form of discharge can often buy the affected with ample amount of time to seek diagnosis via ultrasound, mammography or biopsy.
Prognosis, medical prospect of the course of the disease in a patient is important for treatment decisions as patients with good prognosis are subjected to less invasive treatments, such as radiation, while those with poor prognosis are given more aggressive treatments, such as chemotherapy drugs and mastectomy (surgical removal of breast tissue to remove the tumour).
The answer to why alarm bells have rung for Pakistan in this particular case is evident from the fact that approximately 90,000 breast cancers are being annually reported in the country with over 40,000 deaths, bringing Pakistan at the top of the list of Asian countries in terms of rate of occurrence of breast cancer. The problem is most complex in rural areas where women suffer at the hands of the disease as an inherited one and where screening centres are not available for diagnosis.
The breast cancer movement and the subsequently created awareness have their share of achievements, including increased resources for treatment and research, and much higher level of education in patients. Awareness and over-awareness go hand in hand which has negatively impacted the health of normal, unaffected people by creating anxiety. Diagnosis of precancerous, harmless tumours and their removal by radiological and surgical procedures is also a leading cause of death in such cases.
Bearing this in mind, it can be safely concluded that none of the precautionary measures can assure non-occurrence of breast cancer in any individual, and the same holds true for the presence of one or many signs and symptoms and its definite onset. Many times anxiety can choose a destiny for us that we have never wished for. Therefore, regular screening and adopting a healthy lifestyle are the only things that can and should be done, apart from hoping for the best.
The writer is a student of biotechnology with an interest in current affairs, politics and journalism
Published in Daily Times, October 22nd 2017.