Forget myth, get the mammogram

Breast cancer doesn't discriminate by gender, age or lifestyle

KARACHI:

Even as we're riding the tail end of Breast Cancer Awareness Month and informational campaigns fill the airwaves aplenty, misconceptions about breast cancer cling to people's minds, providing them with a temporary shield of comfort.

Breast cancer is perhaps unique in its associations, often sparking discussions around femininity, identity, and disfigurement. I spent a summer at a reputable hospital interviewing patients and publishing their stories, many of the cases being breast cancer. For these women, the thought of a mastectomy - a potentially lifesaving surgery to remove the breast and the disease - carries with it concerns about body image and self-worth.

Diagnosed women can't help asking their husbands, "Will you still love me if I lose my breasts?" Usually half-joking, but the question is also more of a reassurance. Still - does a wife asking a husband that specific question result from a kind of primordial sexism? The association of femininity and breast cancer is pernicious, because it genders the disease. It implies that our womanliness is diseased, not our bodies.

Not only women

One of the more - if not most - persistent myths about breast cancer is that it's exclusive to women. This assumption often leads men to overlook warning signs and delay seeking medical advice. "I found out accidentally," says Faheem Abbas, who was diagnosed with breast cancer earlier this year. "I started lifting weights and noticed I was only developing muscle on the left side, and that there was pain on the right side," he explains. "I then noticed an abrasion on my right breast and showed my wife who also felt a lump. After a biopsy, it was clear it was stage two cancer."

The idea that breast cancer is a women-only issue is archaic, and it leaves men feeling blindsided when it strikes. "I was in denial," revealed Abbas. "You hear of women's breast cancer a lot, but you never hear of men until someone you know comes along." Just because something is uncommon doesn't mean it's not possible.

A study from the National Cancer Registry revealed that out of 269,707 cancer patients in the country who were analysed, with both genders combined, breast cancer was the most common. We all have breasts, and cancer doesn't care how uncomfortable the conversation makes us. "There's absolutely no shame in it," Abbas adds as a message to other men, rejecting any stigma attached to the diagnosis.

The reality of it all

One of Pakistan's foremost breast surgeons, Dr Abida Sattar, has a clear message for anyone who uses the term "prevention" loosely: "We really can't prevent breast cancer. And if we can't prevent something, then the second-best thing we can do is detect it early."

According to her, myths about immunity from breast cancer are dangerously misleading. One of the major ones being that women who have just given birth or are breastfeeding are immune. She emphasises, "Despite a healthy lifestyle, exercising, and having absolutely no family history, you can still get breast cancer. Most cases are sporadic. If you are going to wait to find a lump or for something to become physically detectable—you may have waited too long," she tells The Express Tribune. Her words urge people, particularly those over 40, to get regular screenings.

Breast cancer can also progress silently in its early stages. You'll likely be asymptomatic and have a very normal self-exam as well as a doctor's exam. Dr Sattar's advice is straightforward: "All lumps and bumps are not cancer, but all lumps and bumps require medical attention."

For those who experience this silent battle, the emotional journey often parallels the physical one. Nadia Jamil, actor and breast cancer survivor, was unable to get back to The Express Tribune but reflected on this complexity in a previous interview, sharing, "The daunting question was how to let go and survive heartbreak, a potentially fatal disease and then a mind assaulted by depression - all at the same time. But I was given a new lease on life, and I survived. Ironically, it was pain that helped me to evolve and move on. I now find myself grateful for and to everything, both the pain and pleasure."

The 'zaat paat'

The treatment has seen tremendous advancements over recent years, particularly in surgical options. It has gone from radical surgery where they would remove the entire breast and chest muscles to something now called breast conservation. The breast can be preserved and can also be reshaped so women who feel anxious about loss of femininity don't have to face that trauma.

Alongside surgical improvements, systemic therapy options have continually evolved, significantly enhancing patient outcomes. The surgeon emphasises the importance of understanding that breast cancer can spread through the body: "We tend to think breast cancer is a localised disease, but cancerous cells can enter your system and could be affecting the rest of your body as well." The nature of the tumour, known in Urdu as "zaat paat," also influences treatment.

For men with breast cancer, the treatment path is often less clear. "The protocol for women is very clearly defined," Abbas explains. "But for men, they don't have enough global studies to be able to track it properly." Without male-specific research, doctors frequently adapt protocols from female cases. As Abbas notes, "What a lot of doctors - and what my oncologist also did - was borrow that protocol."

Challenges of reaching

For Dr Sattar, breast cancer awareness goes beyond the well-equipped hospitals in big cities. She has spearheaded programmes in areas like Dadu, Gilgit-Baltistan, and Chitral, where access to mammograms and trained personnel is limited. Reflecting on the World Health Organisation's guidance, she points out that in areas with limited screening options, awareness becomes even more critical.

Dr Sattar says, "In an ideal world, we would catch it through screening before it reaches a stage where you can detect it with the human hand, but in places that don't have the facilities, we can educate them to seek help once they feel a physical change."

But education shouldn't be a priority only in October. When everyone sees pink ribbons, posters and case studies, they remember that breast cancer is something they are susceptible to as well. My mother went in for a mammogram three years ago. She was told her scan was inconclusive and that they would like her to get an ultrasound instead. She finally went in for that ultrasound three days ago after reading about an eerily similar case to hers in an awareness post on Instagram. Imagine if that post wasn't reliant on a month, people wouldn't have to wait an entire trip around the sun - or more - to follow up.