Challenges

Pakistan is a classic example of both liberal and conservative lifestyles. Male domination, social stigmas and lack of awareness in majority of the population is playing a perilous role in developing diseases like breast cancer. Also the fact that women tend to conceal their gender related issues. As a result, Pakistani women are at high risk of developing this killer disease.

A one year study was carried out at Rawalpindi General Hospital to find out the level of awareness about breast cancer amongst females present in a public hospital. Among 400 patients with a breast problem 84 (21%) had breast cancer of which 73.81% were in stage III or IV. Average time lapse was 16 months. The underlying cause of delay was ignorance. 600 women with no breast problem were also interviewed for their knowledge of the disease, 69.80% were totally ignorant, 18.40% were partly aware and only 11.80% were fully aware. 87.75 had no idea about breast self examination, 68.2% did not understand the significance of a lump in the breast and its lethal potential. Unawareness was even prevalent among the highly educated (55%) although it was less than the illiterate (82%) and the lowest income group (85%). The prime source of information was either a friend or relatives followed by the electronic and print media, with health education playing a minor role.

The inherent challenges encountered during the Pink Ribbon Campaign include:

Illiteracy: In Pakistan, female literacy rate is 36%, whereas 77% of the females have not completed higher secondary school. Lack of education and awareness has rendered women oblivious of the occurrence of breast cancer and its vicious effects. The greatest challenge lies in directing a message that is easy to understand for the urban and rural women, without offending the social and cultural beliefs of these women and their families.

Taboos: The success of a campaign depends on the strategy to cope with the popular misconceptions among the masses related. Unwillingness to understand is not an issue of the illiterate only, people at large tend to resist novel concepts and needs. The taboos affirm that breast cancer is a very sensitive issue and women generally shy away from addressing breast related issues and feel uncomfortable in discussing them. The reluctance further increases with a fear that disclosure of the disease will affect the future of sisters and daughters of the patient by not getting married. Hence, reaching out to women, removing their shyness and misconceptions and educating them on preventive and early diagnosis method is a huge challenge relevant to all segments of women alike.

Myths and misconceptions: Some of the myths and misconceptions include:

1. Breast cancer only affects older women.
2. If breast cancer does not run in your family, you will not risk it.
3. Only your mother's family history of breast cancer can affect your risk
4. Breast cancer is a contagious disease.
5. Breast cancer can be a result of a curse/evil eye.
6. Breast feeding increases the chance of breast cancer.

All these myths and misconceptions cause a delay in the process of diagnosis and treatment.

The B-word and media: Running a campaign on breast cancer awareness in Pakistan required changing mindsets. While talking about the issue of CA Breast, media in Pakistan was not ready to differentiate between education and obscenity; and refused to air any news or programs on this topic. Getting them to comply was a later challenge, just making them recognize the importance of breast cancer awareness, its high prevalence in Pakistan and the need for mass communication had been and continues to be our greatest challenge.

Lack of medical facilities and infrastructure: Poor access to healthcare, lack of medical facilities and infrastructure not only limits the early diagnosis of breast cancer but also hinders treatment of the deadly disease. The existing government and private hospitals are insufficient to cater for the growing number of cancer patients and lack resources to provide adequate diagnostic and treatment facilities. There is no concept of Annual Screening or Mammogram for women aging 40 or above as either it is not available or is very expensive. The available human resource in health sector in Pakistan is dismally low as it shows a ratio of 1,254 people per doctor, 2,671 per nurse, 6,235 per midwife and 18,318 per Lady Health Visitor (Economic Survey 2006-07, Pakistan).

Lack of specialized human resource: The number of specialized human resource e.g. surgeons, oncologists and radiologists specifically female doctors is too low; as specialized facilities are limited to some main cities of the country. The rural areas first of all lack doctors and then absenteeism of female doctors, nurses and paramedics further aggravates the situation. Furthermore, the rural community finds it more fitting to go to a peer/imam masjid for a special prayer that they think will dissolve the cyst or to a Hakeem for alternative medication or to a barber shop for rudimentary surgery of the cyst. This kind of delay proves to be fatal for patients.

Absence of cancer registry: Research and development is at its lowest in Pakistan and the absence of a Cancer Registry further substantiates this. There is no official collection of data, analysis or availability of statistics, and hence the prevailing national scenario is vague.

Lack of national cancer prevention program: Welfare countries across the globe support National Cancer Prevention Programs that operate through the amalgamated efforts of national organizations, state health agencies and other key groups to develop, implement, and promote effective cancer prevention and control practices. However, no such program exists in Pakistan.