What We can Do

What's killing us....

I was having a discussion with a friend, and he brought up the topic of NCDs (non-communicable diseases). We discussed CV disorders, and he seemed pretty intent on finding a way to prevent smoking--which, incidentally, is the leading cause of CVDs. But hey, here is our problem: haven't we done enough to prevent people from smoking? We have arranged seminars, posted outside building walls (a proud tradition), hosted walks and marathons and tried everything we could to get people to stop picking up the death stick. And we have succeeded too, although only through a minor fraction. Smoking is what we are already focusing on. It's bad, and nearly everyone knows it. But there is a killer more deadly, and more silent than smoking and CVDs, and that is cancer.



Now I do not have a degree in oncology (and probably never will get one), nor am I an authority on the subject. But just by twiddling with the statistics, we can safely say that cancer accounts for nearly 13% of all deaths. That's a lot less than the 30% for CVDs, but considering that a whooping fifty-nine million nine hundred sixty-four thousand (yup, you read it right) people die each year (roughly), that 13% becomes seven million seven hundred ninety-five thousand three hundred twenty, a number slightly more than the population of Hong Kong. And that basically means one thing: we shouldn't take cancer lightly. We can make a whole Hong Kong out of the survivors.

There are obviosuly different forms of cancer, but the one we're concerned with at present (for reason's I'll explain later) is breast cancer, Now breast cancer ranks third on the world list of mortal cancers, but when we single out the female population, breast cancer slogs top spot. It is accountable for nearly 21% of cancer cases in women worldwide, and as you might have begun to see, it's quite a huge risk.

Now some of the smart ones among you might be wondering why I'm telling you all this. Sure, this is stark freezing January, not October! This isn't breast cancer awareness week! In fact, this article is being written to do what the breast cancer awareness week sadly isn't doing: spreading awareness.

Breast Cancer types.

One of out every sixth (some sources say 1/8 and others 1/4, so this is averaging things a bit) woman in Pakistan faces breast cancer during her life. Considering some population demographics, this makes up nearly 15 million women in Pakistan alone. The risk runs on a parallel scale in some other countries, but this where staging kicks in: most of women in western countries who have breast cancer are detected positive earlier on, and are treated for this disease. A study published in JPMA mentions that only 10% of women are detected at stage III and IV of breast cancer in developed countries, compared to nearly 70% in Pakistan and other developing countries. All this tweaking with numbers has one thing to suggest: women in Pakistan who suffer from breast cancer are diagnosed at later stages compared to other countries.

  
And that, folks, brings us to the original theme: exactly how much aware are we about breast cancer? Well, as full-fledged (some) and wannabe (most of us) medics, we can confidently answer: pretty much. And that's where the second question comes in: how has this helped our society? That is where the problem kicks in.

Nearly 60% women are diagnosed with breast cancer only once they reach a critical stage. That is partly becuase of two reasons: lack of awareness and social taboos. It may be surprising to know that Pink Ribbon Pakistan started work on a full-fledged diagnostic center only last year. Faculties that provide affordable breast examination are few and widely separated, and even then, most people don't get access to them. And even if we build a dozen or so diagnostic centers, the first thing that we will need to fight will be the social taboo. Getting diagnosed with breast cancer in Pakistan is not a good thing, both medically and psychologically. And considering the stigma our society attaches to a number of things, it is easily imaginable how stubbornly we still consider breast examination procedures and centers as unethical. For the sake of one simple statement: "people will talk", we are letting 40,000 women die of breast cancer, and that too, undiagnosed. 

You need to see a doctor...

Not to bring up the actual topic: what can we do? The only plausible and pragmatic approach is to spread awareness. While I admit that certain government institutions, and certain private ones as well, have set up awareness campaigns aimed specifically at rural areas, it is an equally valid fact that the response has much been the same as for polio-vaccination. It is sad but true, that even people living in urban areas do not attach as much importance to this matter as it deserves. 

what we need to avoid

Working on a more personal scale, however, is a bit different from appointing a single LHW for a thousand houses. Most of us belong to diverse backgrounds, and we can use that to spread awareness as far and wide as we can, beginning with our own families. There are dozens of ways to approach early diagnosis, but due to the lack of adequate diagnostic centers, we can purport the most basic one i,e. breast self examination. Many programs such as Shaukat Khanam and the Pink Ribbon Foundation actually take a lot of pains to make informative brochures and stuff that (for the sake of practicality) get distributed in seminars and do not (in most of the cases, at least) reach the people who actually need to read and implement them.

All you need to do is to try and promote awareness of breast cancer and its diagnosis, starting with your own family. In other countries, universities usually arrange cycle tours and other stuff to promote awareness--however, considering our current terror-struck plight, this is hardly a good option. You can tell them about what breast cancer actually is, and guide them as to how they can take steps to diagnose it earlier on. You can show them, using demographics and information, that visiting a doctor is not impractical--in fact, it's the most practical thing they can do if they want to survive. You can also get them to donate for institutes that are working on breast cancer diagnosis and treatment.

No matter what happens, even if we stumble upon a magical cure for cancer [I'd love to do a mythbuster here: most of the supposedly "natural" products that people think will save them from cancer instead of a visit to the doc are about as effective as applying salamander guts to a scab], the most important thing is always going to be early diagnosis. With early diagnosis at stage I there is an 85% chance of five-year survival; with late diagnosis, this falls drastically to only 10%. 



We may not be able to prevent NCDs, especially cancer, 100% but with proper guidelines, we can make sure that cancer remains a disease, and does not become a huge monster threatening to wipe us off earth.

Because that would be worse.   

The happy ending.

NOTE: The stats in this article are not exact values. Quote them at your own risk.

Here are a few brochures and websites that will help you during your task:

http://www.breastcancer.org/symptoms/testing/types/self_exam/bse_steps

https://www.shaukatkhanum.org.pk/images/bcaeng-a.pdf

https://www.shaukatkhanum.org.pk/images/bcaurdu-a.pdf