Breast cancer awareness month: How is Bangladesh doing?

October marks Breast Cancer Awareness Month, a crucial time dedicated to raising awareness about the devastating disease that affects millions of women worldwide. While significant progress has been made in early detection and treatment, the situation in certain countries, like Bangladesh, paints a concerning picture.

Breast cancer continues to haunt women worldwide, claiming millions of lives annually. In 2020 alone, approximately 2.3 million new cases were diagnosed globally, constituting a quarter of all cancers in women. This disease does not discriminate; it infiltrates lives across nations, cultures, and socioeconomic backgrounds. Breast cancer incidence rates exhibit significant disparities globally, ranging from 27 cases per 100,000 in Middle Africa and East Asia to 92 per 100,000 in North America. 

In Western Europe, approximately one in nine women will face breast cancer, contributing to 3–5% of all female deaths. In resource-poor nations, the statistics are grimmer, with 1 in 28 women developing breast cancer in their lifetime. Tragically, for every two women diagnosed, one succumbs to this devastating disease.

Yet, the stark reality is that its impact varies significantly, especially in resource-poor countries like Bangladesh.

The alarming scenario in Bangladesh

Breast cancer is one of the most common cancers globally, affecting both men and women. In Bangladesh, the situation is dire, with a noticeable increase in breast cancer cases over the past decade. As a surgeon, I can give you three essential reasons for this grave situation:

Limited Awareness: A significant barrier to early detection and prevention of breast cancer in Bangladesh is the lack of awareness among both men and women. Many individuals, especially in rural areas, are unaware of the risk factors and early warning signs of breast cancer.

Stigma and Cultural Norms: In Bangladesh, there is still a pervasive stigma around discussing breast health openly. Cultural norms and taboos often prevent women from seeking medical help until it is too late. This hesitation can lead to advanced-stage diagnoses and reduced chances of survival.

Late Detection: Late-stage breast cancer cases are expected in Bangladesh due to delayed diagnosis. By the time many individuals seek medical attention, the cancer has already progressed to a more advanced stage, making treatment less effective and more costly.

Understanding the disease

Breast cancer manifests primarily in two forms: ductal carcinoma, originating from milk ducts in 90% of cases, and lobular carcinoma, emerging from lobules in the remaining 10%. In some cases, the disease remains confined within the epithelium without breaching the basement membrane, termed in situ disease. Breast cancer's ferocity lies in its ability to metastasise. Cancer cells can invade nearby tissues and lymph nodes, setting the stage for distant spread to vital organs.

Clinical Presentation

The clinical presentation of breast cancer can vary widely, but common signs and symptoms include:

- A new lump in the breast or underarm.

- Unusual changes in the size, shape, or appearance of the breast

- Unexplained pain or heaviness in the breast or nipple

- Nipple discharge, other than breast milk

- Unusual skin changes on the breast, such as redness or dimpling

The Triple Assessment

The triple assessment of breast disease refers to a comprehensive approach used by healthcare professionals to diagnose breast abnormalities, especially concerning the possibility of breast cancer. It involves three key components:

Clinical Assessment: This involves a thorough physical examination by a healthcare provider, including the assessment of breast lumps, skin changes, nipple discharge, and other abnormalities.

Imaging Studies: Various imaging techniques, such as mammography, ultrasounds, and MRI, are used to visualise the breast tissue and detect any suspicious masses or abnormalities. These tests provide detailed images that aid in diagnosis.

Biopsy and Pathological Assessment: If an abnormality is found, a fluid (for FNAC) or tissue sample (by trust biopsy) is taken from the affected area. A cytologist and pathologist examine the specimens to determine whether they are cancerous and, if so, the type and characteristics of cancer. Additionally, further tests such as bone scans, CT scans, genetic testing (BRCA-1, BRCA-2), and hormone receptor status studies (ER, PR, HER-2) may be needed.

A Call for Collective Action

Addressing the rising breast cancer rates in Bangladesh requires concerted efforts from the government, healthcare organisations, NGOs, and the community. Here are some crucial steps that need to be taken:

Regular Awareness Campaigns: Initiatives to raise awareness about breast cancer and the importance of regular screenings need to be widespread. These campaigns should target both urban and rural areas and be conducted in languages and formats that are accessible to all.

Improved and Dedicated Healthcare Infrastructure for Breast Disease Surveillance: Investment in healthcare infrastructure, especially in underserved regions, is essential. The establishment of breast cancer screening centres and the training of healthcare professionals in early detection and treatment are critical. Breast units should be launched in every community clinic, union sub-centre, upazila health complex, and urban dispensary.

Breaking Stigma: Encouraging open conversations about breast health and breaking cultural taboos surrounding breast cancer is vital. Community leaders, social media influencers, and healthcare professionals should discuss these topics on platforms like YouTube, Facebook, Twitter, or other social media channels.

Support for Patients: Providing emotional and financial support for breast cancer patients and their families is crucial. Support groups and financial assistance programmes can ease the burden on affected individuals.

Improved Education: Promoting education, especially for women, can empower them to take control of their health. Knowledge about breast self-examinations and regular check-ups can be life-saving.

I have been working with breast cancer patients and performing the surgeries needed for them since 2017, and my experience and exposure in this regard haven't been pleasing or inspiring. Women in our country often bear the burden until the disease reaches its last stage, where little can be done. And so, we witness the mournful fates of these women.

The role of a surgeon in the advanced stages of breast cancer is undeniably tragic. At this critical stage, the cancer has often spread extensively, making curative surgery improbable. Surgeons may still play a palliative role, aiming to alleviate symptoms, improve the quality of life, or manage complications. Their challenge lies in providing compassionate care, addressing pain and discomfort, and supporting patients and their families emotionally while recognising the limitations of medical intervention for any last-stage disease.

Dr Rajib Dey Sarker is a general surgery specialist at Shaheed Suhrawardy Medical College Hospital and an associate fellow at American College of Surgeons

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.