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Ensar is a leading cause of death worldwide. It was responsible for nearly 10 million deaths in 2020 – one in six globally. The most common cancers include breast, lung, colorectal and prostate cancers. In 2022, an estimated 2.3 million women will be diagnosed with breast cancer. However, Pakistan lacks a central registry. An annual mortality rate of 44% is reported among the approximately 90,000 women diagnosed each year. The Nuclear Medicine and Oncology Division of the Pakistan Atomic Energy Commission operates 17 cancer institutes around Pakistan. The most recent data covers the timeline from 2015 to 2019. The most vulnerable age group was 40-69 years. Two out of five women had this disease. Punjab had the highest number of breast cancer cases, due to greater awareness and easy access to diagnostic services. A 2016 study in rural Punjab (Majeed A; Annals of PIMS; 2017)) found that the most common type of cancer was invasive ductal carcinoma of breast tissue, followed by lobular carcinoma.
According to the World Health Organization, some of the most well-known risk factors for breast cancer are being female and the risk increases with age, obesity, alcohol consumption, and tobacco use. A famous fact was the family history. Women whose mothers, aunts, or sisters have had breast cancer have an increased risk of developing breast cancer, especially mutations in the BRCA1, BRCA2, and PALB2 genes. History of radiation exposure was also noted as a factor. Reproductive history, for example, age at first pregnancy, timing of menstrual cycles, and use of postmenopausal hormone therapy. Half of all cases occur in women with no risk factors other than being female and aging. It is important to note here that breast size does not affect the risk of cancer. However, women who have already had breast cancer are slightly more likely to develop cancer in the second breast.
In most women, breast cancer first appears as a breast lump. Other symptoms include changes in appearance or skin, nipple discharge, vomiting, rash, swelling in the arm or armpit lump. Early detection is very important. A breast lump occurs when abnormal breast cells grow out of control, forming a tumor. They can start in the milk ducts or breast lobules. An in situ cancer means that it has not invaded the surrounding tissue. Once it strikes, it is considered offensive. Cancer cells can spread to lymph nodes and other organs (metastasize). Changes in the size, shape or appearance of the breast should also be mentioned: skin changes (dimpling, redness, pitting); Changes in the nipple or surrounding skin and unusual or bloody discharge from the nipple should also be reported by female patients.
Patient-related factors—such as fear, neglect, and financial constraints—are far more important than physician- or system-related delays. Breast cancer awareness and culturally sensitive educational campaigns are urgently needed to reduce fear and encourage early medical consultation. A cross-sectional study (Habibullah S; PJMR 2016) focused on a large public sector hospital, providing insight into the challenges of Pakistan’s health care system for women of low socioeconomic status. This study confirmed that patient delay is an important factor in breast cancer diagnosis delay in Pakistan. Fear of assessment, lack of awareness and financial constraints form a triad of major barriers.
These findings are consistent with global evidence from other low- and middle-income countries, where social and economic factors outweigh system inefficiencies in causing delays. Interestingly, younger women (18-25 years) are more likely to delay diagnosis – possibly due to denial, social stigma, or the perception of being “too young” for cancer. In contrast, health care and institutional delays were relatively minor, indicating adequate clinical response after patient care.
Zaheer etc. BMC Public Health (2019) observed data collected from three major tertiary care hospitals in Karachi, Jinnah Postgraduate Medical Center (JPMC), Karan and Civil Hospital Karachi. A total of 9,771 female cases (aged 15+ years) were analyzed. Earlier, the incidence rate of breast cancer was highest among women aged 60-64 years. However, between 2016 and 2025, breast cancer cases are expected to increase significantly among women aged 50-64 years. The projected incidence of breast cancer is estimated to be around 23.1% in 2020 and 60.7% by 2025. In particular, cases diagnosed among younger women aged 30–34 years are likely to increase rapidly, from 70.7% in 2020 to 130.6% in 2025.
Initially, breast cancer is detected on a mammogram. A mammogram is a low-dose X-ray of the breast that is used to detect early signs of cancer, often identifying tumors before they are physically visible. When a mammogram looks white, it means that the breast tissue consists of more glandular and connective tissue than fatty tissue. Both dense breast tissue and tumors appear white on mammograms, making it difficult to distinguish a lesion or cancerous area from surrounding tissue. This may cause a recall or delay. To overcome this limitation, 3D mammography is recommended. A 3D mammogram takes clear, layered images of the breast, helping doctors find hidden cancers more accurately and reducing the chance of missed or false results.
Additionally, ultrasound and MRI are being performed in tertiary care hospitals. For high-risk women (eg, those with a genetic predisposition such as BRCA 1/2, or with chest radiation at a younger age), the guidelines call for earlier and more intensive screening, including an MRI starting in the 20s to 30s, and an additional mammogram before 40, depending on risk. Regarding breast cancer awareness and screening, a 2016 retrospective study in rural areas around the capital Islamabad (Majeed A; Annals of PIMS; 2017) revealed alarmingly low awareness and limited diagnostic access. Of the 5,000 women screened, many cases were detected, emphasizing the urgent need for early detection programs, mobile screening units and education campaigns. Increasing rural access could greatly reduce Pakistan’s growing breast cancer burden. These findings indicate an urgent need for national-scale, prospective screening initiatives combined with public education to reduce breast cancer mortality in Pakistan.
The World Health Organization Global Breast Cancer Initiative has set a target of reducing breast cancer-related deaths worldwide by 2% each year. Campaigns, such as Breast Cancer Awareness Month in October each year, are important because they remind everyone that early detection through regular self-exams and screenings can save lives. It encourages patients to value life, support and communicate with survivors, and remember loved ones who have passed away.
Breast cancer is treated with a combination of chemotherapy and surgery. Chemotherapy usually involves giving three different drugs every one to two weeks for six to eight cycles. It helps the tumor shrink and can downstage the cancer (for example, from stage 3 to stage 2), making surgery easier and more effective. Surgery remains the primary and definitive treatment, as it removes the cancer completely. Chemotherapy is sometimes given after surgery to prevent the cancer from coming back. Even when chemotherapy appears to eradicate the disease, surgery is still necessary to ensure a complete cure and long-term cure. Radiotherapy is usually given after breast cancer surgery to kill any remaining cancer cells and prevent recurrence. This is necessary after breast-conserving surgery and may also follow a mastectomy if the tumor is large or has spread to the lymph nodes. This late stage has improved long-term recovery and survival.
Several organizations in Sindh are providing vital chemotherapy and support services for breast cancer patients. Cancer Foundation Hospital offers cost-effective chemotherapy under the supervision of qualified doctors and trained nursing staff. A free cancer hospital and hospice, Bethulkun provides curative and palliative care to patients in need. Patient Support Foundation, JPMC Karachi, ensures that no woman delays breast cancer treatment due to financial constraints. Pink Ribbon Pakistan is establishing a dedicated breast cancer hospital and provides financial support for chemotherapy through donations. Patients can contact the Cancer Foundation Hospital or Bait Al Sokoon directly to inquire about chemotherapy programs and eligibility. They can also reach out to Patients Aid Foundation or Pink Ribbon Pakistan for financial assistance. A local charity such as a cancer welfare society can also help with treatment costs or logistics. The aim of these efforts is to make breast cancer treatment more accessible and affordable for all women of Sindh.
A situational analysis in collaboration with the Organization for Economic Co-operation and Development 2021 Khabar Pakhtunkhwa Breast Cancer Subcommittee revealed a severe lack of diagnostic facilities – only 11 mammography machines are available for the province’s 35.5 million residents, with an urgent need to expand breast cancer screening infrastructure in Khatunwar.
Till now, there were no dedicated breast cancer centers in Balochistan. The provincial government has now launched a free cancer treatment programme, marking a major step forward in accessible cancer care. As part of this initiative, a dedicated ward for cancer treatment has been made operational at Bolan Medical College. Under this programme, expensive injections worth up to Rs 1.3 million are being provided free of cost to cancer patients. Additionally, patients can seek treatment at larger facilities in other cities, such as the Pakistan Institute of Medical Sciences in Islamabad or the National Radiotherapy and Oncology Centre. Radiotherapy services are available only in Quetta, Balochistan, primarily through the Noori Nuclear Energy Cancer Hospital, which offers advanced external beam radiation and brachytherapy. Other facilities are located at Mena Atomic Energy Cancer Hospital in Peshawar
Chemotherapy for breast cancer is available in many reputed public and private hospitals, but is mainly concentrated in Lahore. These include Shaukat Khanum Memorial Cancer Hospital and Research Centre, King Edward Medical University Department of Oncology and Anmul Johari Energy Cancer Hospital. The newly established Pink Ribbon Hospital in Lahore is Pakistan’s first dedicated breast cancer hospital, providing free diagnosis and treatment for deserving patients.
According to the American Cancer Society, when breast cancer is detected early and is at a localized stage, the five-year relative survival rate is 99 percent. As we observe Breast Cancer Awareness Month, let’s turn awareness into meaningful action. Together, we can promote meaningful education, ensure early detection and advocate for accessible, equitable treatment for every woman – regardless of background or income. Real progress is in research, not just awareness. Investing in metastatic breast cancer research will save lives, bring hope and bring us closer to ending breast cancer deaths.
The author is a family physician at Evercare Hospital, Lahore.
