In the past few decades, Asia has seen rapid economic growth resulting in increasing life expectancy, declining mortality from communicable diseases and westernization of lifestyle. While these developments are overall beneficial, they come with a price. Female Breast cancer incidence is rapidly increasing in Asian populations. One in ten of all new cancer diagnosed globally every year, is a cancer of the female breast, and it is the most common cancer in women in both in developed areas and developing areas. It is also the principal cause of death from cancer among women globally. The incidence and mortality of breast cancer continues to rise rapidly in Asian countries.
Age-incidence Variation of breast cancer risk
Breast cancer incidence has a distinctive age-specific variation. Incidence rates of breast cancer elevate sharply with age, becoming substantial before 50 years of age. During the premenopausal years, the rate of increase in incidence is common around the world, approximately 8%-9% per year. The elevated rate of breast cancer incidence continues throughout life but slows substantially after menopause, to approximately 2-3% per year. Reproductive hormones account for this dependence of incidence on menopausal status.
Breast Cancer in Pakistan:
Cancer is affecting everyone, children and women, the old and young, the poor and rich. It is creating severe financial and social problems on families in Pakistan. Pakistan is a developing country and most of the population is living in rural areas. In rural areas of Pakistan, no formal health infrastructure is available for rural population. Lack of education is also a major cause of breast cancer among women because women have no awareness about personal hygienic conditions. Most of the Pakistani women have no proper access to the medical facilities due to gender-based discrimination. More than half of the population is based upon women. In rural areas of Pakistan, the main reason for the poor health of the women is socio-economic condition.
In Asia, Pakistan has the highest rate of breast cancer. Young women also present at advanced stage of breast cancer, which has negative effect on prognosis. In rural areas, rural women are developing a great number of breast cancers every year because it is an inherited disease, which is transmitted from mother to daughter. Pakistani rural as well as urban women are facing cervical, ovarian and uterine cancers. Screening centers are not available in Pakistan to diagnose various type of cancer and every year a great number of women are dying due to breast cancer and Hepatitis-C.
Mortality trends varied across the region, with large increases in several Asian countries. About 522,000 females (13 per 100,000 populations) were estimated to have died from breast cancer globally during 2012, including almost 116,000 deaths (22%) throughout the Asia-Pacific region at a rate of 8 per 100,000. Breast cancer was estimated to account for 9% of cancer-related deaths among females in the Asia-Pacific region overall, ranking fourth behind lung, liver and stomach cancers.
Causes of Breast Cancer:
- Significant Family History
- Genetic Causes
- Hormonal causes
- Life style and dietary cause
- Environmental cause
Influence of changes in lifestyle
The same range of hormonal, acquired and intrinsic risk factors for breast cancer have been identified women. While undeviating breast cancer risk factors have been identified, the level of exposure to each specific factor may vary according to a woman’s culture, ethnicity and place of residence. For example, the decline in parity, the decline in breastfeeding and its duration, the fall in age at menarche, the increase in fat consumption, the westernization of lifestyle and diet in parallel with a potential decline in the consumption of traditional foods containing soybeans, and an associated increase in obesity — all can be contributing to the rise in breast cancer risk being observed in East Asian women. Reproductive issues that impact on lifetime exposure to estrogen have a particularly crucial role in the potential for development of female breast cancer. Numerous case-control studies have established that the main risk factors for breast cancer in Asian women include early menarche, late menopause, older age at first delivery, and a lower number of full term pregnancies. The prevalence of these reproductive risk factors is on the rise in Asia. For example, family planning initiatives have brought about sustained declines in fertility rates across the region over recent decades.
Sign and symptoms
- lump found in the breast or armpit
- nipple discharge (clear or bloody)
- pain in the nipple
- inverted (retracted) nipple
- scaly or pitted skin on nipple
- persistent tenderness of the breast
- unusual breast pain or discomfort
. In Advanced stage (Metastatic) of disease underarm lymph nodes are present with other symptoms such as bone pain (bone metastases), shortness of breath (lung metastases), drop in appetite (liver metastases), unintentional weight loss (liver metastases), headaches, neurological pain or weakness.
Obstacles involved in managing breast cancer:
Survival from breast cancer depends mainly on early detection and access to optimal treatment. There are several cultural and economic obstacles involved in managing breast cancer in parts of the Asia-Pacific region, including
- misunderstanding about the disease (such as the incorrect idea that surgery will cause cancer cells to spread more quickly),
- geographical isolation,
- lack of education and awareness,
- inadequate diagnostic equipment and treatment facilities,
- competing health care needs
- A reliance on traditional remedies.
These factors may influence treatment decisions and adherence. Social implications, such as the possibility of abandonment following a mastectomy or the perception that a breast cancer patient may become a burden to her family, can also cause fear, denial and reluctance to visit a doctor.
Delayed presentation is a major problem that stems from these barriers, with a high proportion of women with breast cancer in less developed Asian countries being diagnosed with advanced disease. Tumors tend to be large with poorer histological grade, and many have lymph node involvement or distant metastases. Access to mammography is also limited in many developing countries
Management of Breast Cancer:
- Doing monthly breast self-exam (BSE) is a great way to be familiar with the breasts’ texture, cyclical changes, size, and skin condition.
- Surgery to remove breast cancer (Lumpectomy)
- Surgery to remove breast (Mastectomy)
- Breast reconstruction
- Surgery to remove lymph nodes
- Radiotherapy for breast cancer
- Chemotherapy for breast cancer
- Hormone therapy
- Targeted cancer drugs
Making treatment decisions
It’s important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. It’s also very important to ask questions if there is anything you’re not sure about.
This article is collectively authored by Yasra Sayyed, Ammar Ahmad*, M. Usman Saleem**Pharm-D 9th semester, University of Agriculture Faisalabad, *DVM 7th semester, University of Agriculture Faisalabad **Pharm-D 9th semester, University of Agriculture Faisalabad.