Awareness could have saved her a lot of trouble

Catalina tells her story of bravery and survival

I will take this opportunity to share with you, my journey through breast cancer, recovery and feelings about the disease.

In 1987, after the medical examination for my first job, I was told that I had a nodular breast and required a mammography. Through radiography, a surgeon was quick to offer his services for surgery, another believed that as those were not cancerous; surgery was not required and he prescribed me hormonal therapy. The nodules reduced and surgery was avoided but the nodules came back after a few years of having my last child. Since then, I am having mammography and breast ultrasound on regular basis. FNA on the nodules were also done, results showed that the situation was normal. In 2006, the surgeon suggested an annual mammography, but I overlooked his recommendation and went for the mammography in 2008.

In that regular check up, a malignant tumor was detected. Doubtless of my understating of having a nodular breast and its possibility of becoming the breast cancer made me not to falter on the regular check up. I had to be wary of cancer because my older sister and parents have had the cancer, though none of them had the breast cancer. All of them are well and have survived the disease, thanks to God, early detection and follow up.

On receiving the results of the biopsy, I decided that I would not escape farther surgery and the chemotherapy. The moment you receive the positive biopsy, the whole world turns around and one is very scared of the time ahead.

All the treatments were done according to International Standards and Protocol, with the best drugs and at the best cancer hospital of Islamabad/Rawalpindi. Throughout the treatment, I remained active and engaged. I was able to handover part of my work. I wore a hijab or a scarf to hide my bald head. During the days, I was at home recuperating from the Chemotherapy; I took up embroidery as it was a way of keeping my mind on something else. I regularly exercised my affected arm. It was very encouraging to find a lingerie shop that provided relief to the mastectomy patients. With the continuous support of my family, my religious faith, the prayers, the holy water from Mecca were important in keeping my spirit strong.

"Another important factor that influenced my recovery was the emphasis I placed on diet. I followed all what fellow patients, doctors and common sense recommended me. I ate according to which date of the treatment I was going through"

People are getting cancer more often and earlier than before. This is an alarming general trend that our oncologist and public health doctors should be investigating. As for the breast cancer I had, it was responsive to estrogens and progesterone. I blame my diet and exposure to these substances for its early onset. I took for three years a natural supplement called Famicol. It worked well for the alleviation of symptoms of menopause, but perhaps its composition of phytoestrogens accelerated the appearance of the cancer. Estrogens are given by the poultry farmers to the chicken and the livestock farmers to their animals. The milk maybe tainted with estrogens. We use plastic and melamine dishes to warm up food in microwaves, dioxins and other carcinogens are transferred to the food and liquid. Much more research work needs to be done to understand the link among the pesticide residues and hormones in Pakistani food and breast cancer. Awareness of the women, family doctors and regular breast ultrasound and mammography is required for the early detection of breast cancer and its successful treatment.

Pink Ribbon Campaign in urge to provide best breast cancer diagnostic facilities in Pakistan

Not so long ago, breast cancer was discussed in hushed tones. Women tended to suffer silently rather than seeking care. When advancements took place and long-term survival rates improved, women began getting awareness of the disease and the possibility of successful treatment.

Unfortunately in Pakistan, breast cancer is one of the most common cancers found in women. Statistically proved, 40,000 women die every year of breast cancer in Pakistan and still many cases are left unreported.

"Pink ribbon Campaign Pakistan (PRC) commenced its operations in 2004. Till now, it is the most prominent symbol of breast cancer awareness just like in other parts of the world. PRC has been very fortunate to get constant support from thousands of people for the work that is being carried on regarding breast cancer awareness"

Now, due to its endless effort and dedication, Pink Ribbon has reached a point where women from rural areas approach to doctors in cities for early diagnosis and treatment. Despite the fact, that still, there is a huge gap to overcome to curb down the number of deaths per year, which is obviously not only through creating awareness but also facilitating the demand that has been created for early diagnosis.

Pink Ribbon aims to build Pakistan’s first ever Dedicated Breast Cancer Hospital that will provide state-of-the art facilities for early diagnosis whilst raising awareness for women to get themselves checked before it’s too late. Pink Ribbon is seeking support from corporate sector, Government institutes and public at large, to come forward and build a much needed diagnostic centre which will protect thousands of women and eventually thousands of families as well.

The idea behind this Breast Cancer Hospital is to provide the best available facilities to women as they deserve to be provided with breast clinics in our country to be treated on time, for a better and healthy life.

Overcoming cultural barriers to secure social change

Pakistan is ranked 135th on Gender Development Index of 174 countries and ranks lowest in the South Asian region in terms of GDP per capita for women. It ranked 100 out of the 102 countries measured on the Gender Empowerment Measurement (GEM) 1999. The level of women’s health in Pakistan is among the lowest in the world, according to a World Bank report. In the conservative society of Pakistan, women cannot dare to say anything about the female breast in the public domain or even in private. On top of that, the increasing radicalization of the conventional Pakistani society makes it difficult to talk about breast cancer awareness, the single largest cause of death for women in Pakistan.

In 2001, the situation towards breast cancer was so critical that the word “breast” was considered vulgar on state TV and there was no concept of a discussion on awareness. This is why in 2003, Pink Ribbon Campaign was launched. Pakistan has the highest rate of breast cancer in whole of Asia where one in nine women is at the risk of a breast cancer diagnosis, accounting for 40,000 deaths every year. Dismally low public spending on health and a strictly traditional society collude to worsen the impact of breast cancer in Pakistan.

The campaign has used a top-to-bottom approach with focus on public-social-private partnerships. The successful advocacy interventions of the campaign resulted in signing agreements with federal and provincial ministries to include breast cancer in reproductive health packages and ban taxes on the import of all drugs and tests related to breast cancer. Launch of nationwide Youth Awareness Program in partnership with Higher Education Commission and issuance of 500,000 commemorative stamps by Pakistan Post Office have also been successful results.

Through the Ministry of Health we have been instrumental in initiating a trial Cancer Registry and inclusion of a chapter on Breast Self-Examination in the training manual of Lady Health Workers. We also succeeded in running a Free National Breast Screening Program in 14 cities with the support of government.

Pink Ribbon Free Public Service Messages on breast cancer awareness are now being run by all Cable TVs supported by Pakistan Electronic Media Regulatory Authority (PEMRA). Pakistani Prime Minister’s wife became the campaigns’ Chairperson for 2 years. We also hosted a six days visit of the wife of the British Prime Minister Mrs. Cherie Blair to Pakistan in 2006 in support of the campaign.

The impact of the campaign despite the numerous challenges has been significant as according to the statistics of Ministry of Health there has been a 30 per cent increase in patient turn-up at the Breast Clinics nationwide since 2004 when Pink Ribbon started its campaign in Pakistan.


Fighting Breast Cancer

Reducing Your Risk of Breast Cancer: Taking Charge of Breast Health

    The words “breast cancer” may trigger a range of responses including vulnerability, anxiety and uncertainty. Breast cancer has received increased attention due to the significant number of individuals who have been diagnosed with this disease. Most noteworthy however, is the fact that advances in treatments for breast cancer have contributed to an increase in overall survival rates of this very treatable disease.

    Why are we witnessing an increase in the incidence of breast cancer? A possibility may be due to the improvements in screening methods thus, we are finding more breast cancers at treatable stages. Advances in breast cancer awareness, screening and treatment have contributed to the overall increase in breast cancer survivorship. There are a variety of treatments available for breast cancer, which may include surgery, chemotherapy, radiation and anti-hormonal therapies. It is valuable to know that numerous sub-types of breast cancer exist, which in turn, dictate disease aggressiveness, treatment options and overall survival.

    There are some risk factors for breast cancer that cannot be changed, which include being a woman, getting older and one’s genetics.  It is important to know that most breast cancer incidences are not hereditary, which really means that one can take steps toward reducing his or her risk of developing this disease.  Some of the recommended lifestyle changes are as follows:

  • Maintaining a healthy body weight, which may involve losing weight if overweight.
  • Exercising regularly: using the stairs instead of the elevator and joining an exercise class with a friend are some exercise tips. Aim for 30 minutes of exercise per day. *(Do not overdo it; keep hydrated; listen to your body; see your family physician to discuss your exercise plans).
  • Stop smoking.
  • Choose healthy foods, which include foods low in saturated fats, whole grains, fruits and vegetables, and low fat meats including fish and chicken.  *(Be careful not to over consume; watch portion sizes and snacking options).
  • Avoid alcohol.
  • Interestingly, studies have found that breastfeeding is associated with a lower risk of developing breast cancer.  The protective mechanism occurs most significantly in the breasts of women who breastfeed for one year thus, there is less benefit for women who choose to breastfeed for less than one year.  There are a variety of thoughts regarding the rationale for this protective effect.  For instance, while the breasts are making milk, a “differentiation” of the breast cells occurs that may provide some resistance against cancer cells.  Also, while women are breastfeeding, their menstrual cycles often stop, resulting in an overall decrease in estrogen within the body.  Notwithstanding the numerous benefits of breastfeeding, many women are unable to breastfeed due to a variety of reasons.
  • All women can however, incorporate these final approaches into their lifestyle toward breast health.  Having regular clinical exams performed by a health care practitioner/family physician and being familiar with how your breasts look and feel are two very important messages.  The latter message allows women to recognize any changes that may occur.

    Changes may include:
  • A new lump or thickening of the breast tissue or armpit area,
  • Swelling, redness or darkening of the breast,
  • New nipple discharge that does not go away,
  • Changes in your breast size,
  • A pulling in or puckering of the skin or nipple or,
  • A new pain in one spot that does not go away.
  • It may be easier to recognize changes in your breasts if you get dressed in front of a mirror or, perform a self-exam while lying down in bed or while standing in the shower.  When performing a self-exam, be sure to include the “tail” of the breast and the armpit area. The breast tail is the upper portion of the breast extending toward the armpit area.  If you notice any of the above changes in your breasts, an appointment with your health care practitioner/family physician is a good place to start.  An important fact to keep in mind is that most breast lumps, approximately 80%, are not cancerous.

Breast Cancer and the fear of its recurrence

The diagnosis of breast cancer is a trauma in itself, but unfortunately that is just the beginning of a treacherous journey. The treatment leaves deep psychological and physical scars which can take a very long time to heal. Even if a treatment is successful, the leftover residue of emotions, physical fatigue and the danger of its recurrence still lingers.
One of the most common side effects of cancer is depression which has its root causes in many different areas ranging from physical changes to mental exhaustion. In a latest survey of 266 women who underwent breast cancer surgical treatment, the scientists found that more or less one-third of the participants had experienced psychological problems following the treatment, with problems becoming most rigorous four months after the surgery.

When a woman is going through cancer, she undergoes various treatments and is comforted on different levels by family members and professionals and knows that there is a certain route that needs to be followed for its eradication. Once the treatment is finished, it can leave the woman hanging with no proper direction to follow, resulting in a whirlpool of fear and distress. Cancer patients will always live with the fear of its recurrence, thus it is essential that along with routine check-ups, they educate themselves on the topic in order to be prepared in case it happens. Recurrence can take place at any time, but most recurrences occur in the first three to five years after initial treatment.

A breast cancer recurrence can be:

Local: happening in the locality of the original tumor.
Regional: Occurring in lymph nodes surrounded by the region of the initial cancer
Distant: appearing at a distance from the original place.

How to look out for a recurrence?

For breast cancer treatment, one should continue to practice self-examination, checking both the treated area and the other breast as well each month. Any changes should be reported to the doctor right away. Breast changes that might indicate a recurrence include:

• An area that is distinctly different from any other area on either breast
• Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle
• A change in the size, shape, or contour of the breast
• A mass or lump, which may feel as small as a pea
• A marble-like area under the skin
• A change in the feel or appearance of the skin on the breast or nipple, including skin that is dimpled, puckered, scaly, or inflamed (red, warm or swollen)
• Bloody or clear fluid discharge from the nipples
• Redness of the skin on the breast or nipple

Along with self-examinations, scheduled follow-up appointments should be done with the healthcare provider. Initially, the check-ups may be scheduled every three to four months. The longer you are cancer-free, the less often you will need to see your healthcare provider. Continue to follow your healthcare provider’s recommendations on screening mammograms (usually recommended once a year).

How to deal with the fear?

Choosing a healthy lifestyle is also very important. Other problems such as weight management, exercise and stress cutback should be discussed with the doctor as well. These factors have a big impact on a person’s health and wellbeing and can directly affect the possibility of a recurrence. Living with its fear is one of the hardest things to deal with having gone through such a big trauma in the first place. The best way to deal with it is to seek support, reassurance and to maintain a healthy lifestyle. There are a number of breast cancer support groups which can be of great help. Different forms of exercise and meditation can also help deal with the stress. Most importantly, it is imperative that a person keeps a positive outlook on life as negativity results in stress and is one of the leading factors of recurrence. Like Eleanor Roosevelt said, “You have to accept whatever comes, and the only important thing is that you meet it with courage”.

Psychological Impact of Breast Cancer and Family Support

The diagnosis of breast cancer is one of the most traumatic experiences a woman can undergo. Being the leading cause of cancer among women, special attention needs to be given to its management and thus the impact of the disease on the patients’ psychological well being is becoming increasing importance. A study, conducted by researchers at Dartmouth Medical School, found that nearly half of the 236 newly diagnosed breast cancer patients in the study experienced emotional turmoil and distress that were clinically noteworthy. Meaning, the aftermath of this disease leaves such a deep impact that leads to sever emotional distress or psychiatric disarray. While the physical side effects of breast cancer and the subsequent treatment of the disease can be complicated for women, the psychological effects of breast cancer can be devastating as well.

"Feelings of depression, sadness and hopelessness are common reactions and can continue all throughout the treatment and recovery"

Depression affects the everyday life of cancer patients by interfering with relationships and the general ability to relax. Seeking professional help through counseling can help patients and their families by providing them a safe environment to express their emotions and to gain knowledge in how to deal with them. This aids in developing a sense of wellbeing that can improve the quality of life of the patient.

Many women feel anxiety in regards to how people in their surrounding will react to their diagnosis. Relationships can become strained and people, like employers etc, might start behaving differently upon learning of the diagnosis. This adds to the anxiety the woman is already feeling. Physical exhaustion is enough to deal with for a patient going through cancer therapy, which ultimately has an effect on the person’s mental health. Fatigue is a common side effect of chemotherapy, but nervous exhaustion can lead to other emotional side effects if not managed properly.

Getting professional advice even in this matter can be helpful as it provides the patient with ways of coping with the situation. Moreover, it is always better to let your feelings out and talk to someone; it unloads the pressure and helps in getting worries off their hearts and minds. Often women react by retracting and closing up into a shell, eating poorly and refusing to exercise. All of these add to the detrimental effects of cancer and the patient should be discouraged from doing so and encouraged in participating in healthy activities despite the feeling of depression and anxiety weighing them down. They can learn better coping skills, how to communicate their distress to friends and family and how to develop more a positive outlook that ultimately can aid in their recovery.

The physical changes that might result in treatment add to the psychological impact of the disease on the patient. Malignancy of the breast is different in that a part of the body, as it is the symbol of womanhood and sexuality. Hence any form of treatment can have a profound on the body image, self worth, sexuality and intimate relationship of the patient. If a woman has undergone a mastectomy, the trauma of losing a breast can be paramount. It is very important for both partners to acknowledge and support each other through the loss and understand that a grieving process is healthy and normal. Hair is an outward expression of a woman’s individuality. Many breast cancer sufferers become devastated at the notion of losing their hair, which is a major factor especially for women. Thus, the woman should be pacified and be repeatedly comforted by their partners or family members, as this support is invaluable.

It’s not stress that pushes a cancer to grow faster: it’s the feeling of helplessness that we sometimes develop when we’re facing stress. This is accompanied by abnormalities in cortisol, which when they persist can prevent the immune system from doing its work, and increase inflammation in the body. The best defense against the feeling of helplessness is to find support from people around you. Leaning on trusted friends and family members is important for the breast cancer patient. Look around and find others of the same faith who have been treated for breast cancer. Look for support groups in the community; usually, hospitals that specialize in breast cancer treatment sponsor these types of groups. Your doctor should also have information about support groups; and join a support group for some catharsis. Family members should also be encouraged to go as ultimately, they also play a very important part in the road to recovery and should learn how to deal with the situation.

Young Woman and Breast Cancer

Breast cancer and younger women are usually not associated together much as fewer than 7% of all breast cancer cases take place in women under 40 years of age. Nevertheless, breast cancer is a real threat and can develop at any age. Thus it is vital that all women, regardless of what age they’re at, are made aware of the dangers of this disease as early detection is the best prevention.

Pakistan has the highest rate of breast cancer for any Asian population accounting to 40,000 deaths per year.  Approximately 90,000 cases are diagnosed with breast cancer every year nonetheless, the number of unreported cases is expected to be much more. But, despite the fact that breast cancer is the leading cause of cancer death in women ages 15 to 54:

  • Many young women and their doctors are ignorant that they are at threat for breast cancer.
  • There is no effectual breast cancer screening tool for women at the age of 40 and under.
  • Young women diagnosed at a later stage than their older equivalents.
  • There is very minute research focused on issues exceptional to this younger population, for example fertility, pregnancy, genetic predisposition, the impact of hormonal status on the effectiveness of treatment, psycho-social and long-term survivorship issues and higher mortality rates for young women.
  • Young women diagnosed with breast cancer habitually feel cut off and have little contact with peers who can communicate to what they are going through.
  • As the occurrence of breast cancer in young people is much lower than in older women, young women are underrepresented in a lot of research studies.
What is different about Breast Cancer in younger women?

For younger women under the age of 40, the diagnosis of breast cancer is more complicated as their breast tissue is generally denser than the breast tissue in women aged over 40. Therefore, it is harder to detect as by the time a lump can be felt, the cancer is mostly at the last stage.

Additionally, breast cancer in younger women may well be destructive and less probable to react to any sort of treatment.

Most young women tend to pay no attention to the symptoms of breast cancer, such as a breast lump or strange discharge. A number of healthcare providers also do not give these warning signs much importance and label them as cysts. But breast cancer is a very big reality and no one should take their health for granted. As women hit their 20s, they ought to be more informed about the dangers of this fatal disease. Women should perform check-ups themselves and report any abnormal changes to the doctor.  A woman can become aware of changes by knowing how her breasts usually look and feel and feeling her breasts for changes, or by choosing to use a step-by-step technique and using an explicit schedule to observe her breasts.

Women with breast implants can also do breast self-examination. It may well be helpful to have the surgeon assist identify the edges of the implant so that you know what you are feeling. Young women who are pregnant or breast-feeding should also examine their breasts on a regular basis. More than 90% of the women who discover breast cancer at an early stage will be successful in their treatment.

As a general rule, regular mammograms are not recommended for women under 40 years old, because breast tissue tends to be denser in young women, making mammograms less effectual as a screening tool. Additionally, nearly all experts believe the low risk of developing breast cancer at a young age does not give reason for the radiation exposure or the cost of mammography. Nevertheless, screening mammograms could be recommended for younger women with a family history of breast cancer and other risk factors which put them at a higher risk of developing breast cancer. Pink Ribbon Pakistan feels that breast self-exams are optional but can be very helpful for women starting in their 20s.  Doctors ought to discuss the benefits and limitations of breast self-exam with their patients and young women should be aware enough to know how to self examine themselves.

How is Pink Ribbon Pakistan helping? 

One of the great challenges Pink Ribbon faces is getting people to talk about the disease and be more open about it.  In Pakistan, especially women, avoid discussing about the issue even when they feel they need to.  Because of this indifference, the condition usually gets worse and when breast cancer is finally detected, it is usually too late.

Last year they were able to directly reach out to

  • 90,000 women to empower them with knowledge and techniques to detect breast cancer at early stage
  • Provided free clinical examination to 5,000 women through expert doctors
  • Provided Free Mammogram Screening to over 700 women