Only 140km away....

awarenessHyderabad, a city located only 140km away from Karachi, is the second largest city by population in Sindh, and the fifth largest city in Pakistan. With its population approaching nearly two million, 48 per cent are females as per the census of 2017. Due to ignorance and low literacy levels along with cultural norms, the women there tend to consider their health the least of their priority after catering to their spouses and children. Hence, they also end up ignoring hygiene of their private parts due to shame and taboos. Dr Sana ZeeshanBreast cancer is the most common cancer affecting women all over the world with Pakistan having the highest incidence in Asia. According to an estimate, one in every eight woman is at risk of developing breast cancer in her lifetime. The incidence of this cancer tends to increase with age, but early detection followed by correct treatment decreases the death rate by almost 30 per cent.Aga Khan University Hospital (AKUH) works hard to reach far and wide in order to spread the awareness regarding the disease and eliminate the myths associated with it, especially in the month of October. Last year, various activities were held in Karachi and we extended our services to the closest city i.e. Hyderabad; there we offered to screen as many women as possible. With a team of seven specialists and two nurses, we conducted a one-day breast screening camp on 30th October 2018. Over two hours, we managed to examine 182 women, with 54 women being above the age of 40 years. Shockingly, we indentified eight women with definite breast cancer based on classical signs upon examination only - that too locally advanced - with the patients being totally unaware of the changes in their breasts. These women were all healthy with no apparent signs of illness. One of these was a local recurrence after mastectomy. One on the spot biopsy was also performed while the others were referred for relevant tests with follow-up appointments.8 out of 54 women randomly examined found to have locally advanced breast cancer. Does this mean that the prevalence of breast cancer in Hyderabad is much higher than what is reported in research, or are the women there unfamiliar with the existence of this looming epidemic? And how many of those with normal examination will be diagnosed with a problem on mammogram? If this is the scenario in the second largest city of Sindh, what is happening in rural areas beyond Hyderabad?A study regarding breast cancer screening camp was published from rural India in 2012 according to which only two women with previous history of breast cancer were diagnosed to have recurrent cancer, out of all the 68 women examined during the camp. None of the other women were diagnosed with breast cancer on clinical examination, radiology or even after biopsy performed for suspicious lesions. In this day and age where social media supersedes all other sources of basic information, our women from rural as well as most urban areas remain deprived of basic health rights. In order to overcome this insufficiency, several important steps need to be taken at institutional as well as governmental level. This includes having more local camps, training and educating local women and health care workers on self-breast examination, spreading awareness through local media, having more diagnostic facilities and trained clinicians. At the institutional level, AKUH has extended its breast clinical services to Hyderabad and offers screening along with diagnostic and therapeutic interventions. Local camps act as catalysts for women to seek medical attention and discuss with local health care workers concerns of discovering new lumps or developing breast symptoms. These should be organised more frequently in different areas and training imparted so as to have a more sustainable model for breast cancer diagnosis and treatment. Women found to have a problem should be facilitated to get appropriate attention at recognised centres capable of dealing with the concerned problem. 140km should only be taken as a number and not as a distance between two cities which makes women incapable to seek medical attention. Nothing should become a hindrance to healthcare for anyone. If they do not reach us, we should reach them.The writer is a Consultant Breast Surgeon and Director Breast Screening and Outreach at AKUH. 

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