I saw a patient yesterday. She was a 40 year old mother of three, her youngest daughter only 6. The patient had gone to a general surgeon because of a breast mass, and she had been referred to me for diagnostic work up.
The lady told me that she had had the mass for over a year. I asked her why she hadn’t seen a doctor earlier, and she said that she hadn’t wanted to draw attention to herself. The family had limited resources, and she had not wanted to become an additional burden.
The year was 1999. I was a final year medical student. We were attending the Out Patient clinic at Mayo Hospital in Lahore. With our professor we saw patient after patient who had ignored a breast mass for a long time before finally giving in to the pain or weakness. I remember one patient in particular who had come from a village near Peshawar. She had ignored her breast mass for a few months. Then she had sought the blessings of her local ‘Pir Sb.’ When that didn’t work, she had gone to a ‘hakeem,’ who had given her a potion which had obviously not helped. More than a year after first noticing her breast mass, she had finally gone to see a local doctor, who had referred her to Mayo Hospital. By the time she made it to Lahore, the cancer had replaced all of her breast and spread to her axilla and beyond. A mass which could have been removed completely a year earlier had now become incurable.
These are sad stories. And these stories are not at all uncommon. Cancer of the breast is one of the three most cancers among women. One in nine women will develop breast cancer in her lifetime. But breast cancer does not develop overnight. It usually begins as a small mass in the breast, which grows ever so slowly for a long time. It is at this stage that a woman should go to a doctor and have the mass examined and biopsied. Most breast masses are benign, but the cost of ignoring a mass that might be malignant is very high. Every day women die of breast cancer which could have been treated if detected in time.
In my experience, most women who don’t see a doctor for a breast mass are reluctant because they are shy to talk about the issue. In other cases, women simply don’t want to ‘waste’ limited resources on their own health. These are terrible reasons to risk the life of a mother, a sister or a daughter.
Unless we start to get over our hang ups and actually talk about this issue, we will never be able to educate women and their families about the risks of breast cancer. We must change our collective attitude towards women’s health and breast cancer. Only then will these sad stories become less frequent.