Breast Cancer Awareness Month – A Glance at Nepal’s Scenario

The Breast Cancer Awareness Month 2018 is being observed throughout October 2018 across the globe to raise awareness on breast cancer and its harmful effects. Let’s take a look at Nepal’s ongoing battle with Breast Cancer.

US Breast Cancer Scenario
According to the American Cancer Society, 2018 is witness to approximately 1,735,350 new cases of cancer. Furthermore, 609,640 cancer-related fatalities are likely to occur in US including 266,120 new cases of invasive breast cancer in 2018.

In an alarming estimate, the cancer treatment cost in US is likely to touch USD 157.8 billion by 2020 and even higher for breast cancer.

Scenario in Nepal
Breast Cancer puts a considerable amount of strain on Nepal, socially and economically. Prevention methods have been the only effective way in lessening the rise of this malignant illness.

However, there is more to prevention than meets the eye. Due to lack of financial resources, socio-economic gaps, inadequate numbers, training and distribution of health-care personnel & equipment, Nepal has not been successful in its prevention measures.

Although Nepal lacks a population-based national cancer registry, it has a multi-institution hospital-based registry that keeps a record of the breast cancer sufferers and related information.

Through various population-based studies performed across Nepal, the most common age of breast cancer patients has been recorded between 40-50 years with a remarkable chunk below 50 years.

Risk Factors

Following are the risk factors that breast cancer brings to patients:

• Early menarche: Maturity before the age of 12
• Late Menopause: Beyond 55 years of age
• Nulliparity: Being unable to reproduce or have the first baby before 30 years

 
As per studies, breast cancer also occurs in premenopausal Nepalese patients with a late menarche (above 14 years of age), early first full-term pregnancy (before 40 weeks of pregnancy) and a longer duration of breastfeeding.

Additionally, delayed childbearing, reduced breastfeeding and other westernized lifestyle patterns were found to be important factors for breast cancer risk and prognosis among Asian women.

Studies also suggest that high dietary fat, smoking excessive alcohol intake, exposure to radiation and hormone replacement contribute to an increased risk of breast cancer in Nepalese women.

Early Detection of Breast Cancer
Unfortunately, Nepal lacks a breast cancer screening program. The malignant disease can be only arrested through early detection, which is an important step in reducing its spread.

Breast self-examination and clinical breast examination are the most effective early detection practices among others. Additionally, studies suggest that Mammography screening can reduce breast cancer mortality risk by 20 percent. Following this, screening may be considered as the optimal method to prevent breast cancer.

Detection methods like high-resolution ultrasound, automated whole breast ultrasound and magnetic resonance imaging are out of reach and too expensive to invest in for a nation like Nepal.

Therefore, it would be effective if early detection methods like awareness and breast self-examination are extensively promoted through newspapers, electronic media, as well as through the support of health personnel.

Methods of Treatment in Nepal
As discussed earlier, factors such as financial position, access to proper healthcare facilities and social condition of the patients are the biggest hindrance to breast cancer treatment.

Following are the methods of breast cancer treatment in Nepal:

• In Nepal, modified radical mastectomy, simple mastectomy or toilet mastectomy are frequently-practiced surgical techniques for the treatment of breast cancer in the country
• Prior to 2009, Nepal witnessed 6-15 percent breast cancer surgeries, of which, the most common one was modified radical mastectomy
• Few Nepalese patients are also offered post-mastectomy reconstruction. However, only a proportion of those offered the option accepted it due to financial constraints
• Additionally, surgical staging of breast cancer through axillary lymph node dissection is still a frequently-practiced process by many Nepal hospitals
• According to a study by Sapkota in 2016, radiotherapy was among the most commonly practiced methods for treatment of breast cancer in Nepal
• Tamoxifen is the most commonly-used hormonal medicine for the management of breast cancer, irrespective of the menopausal stage in Nepal
• A patient’s health status is put into consideration when choosing the most appropriate chemotherapy method for breast cancer. In Nepal, anthracycline-based chemotherapy regimen is most commonly practiced in Nepal

 
Breast Cancer Treatment –The Way Forward
Nepali women lack the required knowledge of breast cancer risk factors. A study on breast cancer literacy among higher secondary students of Nepal indicated that students had poor knowledge on breast cancer risk factors, symptoms and cure.

Furthermore, students lacked awareness of age, early menarche, delayed menopause and usage of the oral contraceptive pill as risk factors for breast cancer.

In another cross-sectional study conducted at KIST Medical College of Kathmandu, 70 percent of the students never heard of breast cancer. The study thus concluded that the understanding and awareness of breast cancer among Nepali women was remarkably poor.

This brings us to the conclusion that the following steps are necessary to enhance breast cancer awareness and healthcare:

• Healthcare settings should increase cancer literacy to ensure the widespread knowledge among general public
• Government should create formal policies for effective nation & district-wide cancer literacy programs and engage with community-level, national & international organizations and healthcare system
• Furthermore, breast health education sessions, guidance by nurses on BSE, regular follow-up by nurses and other healthcare training institutions should be conducted throughout Nepal
• Awareness campaigns should be conducted through advertisements on breast cancer along with screening via radio, internet, television and poster platforms to promote an attitude change regarding breast cancer in women
• Cancer-related curriculum in medical schools with focus on breast cancer awareness and screening methods should be enhanced in the country
• Additionally, future research should be carried out to focus on genetic makeup of breast cancer, for improved understanding on the early onset of breast cancer in Nepal

 
Important Facts about Breast Cancer in Nepal:

• In countries with lesser resources including Nepal, breast cancer is diagnosed at later stages
• According to Nepal Cancer Relief Society, modern lifestyle, lack of exercise and improper diet, pollution and tobacco consumption are some of the major reasons for rising cancer in Nepal
• Breast cancer is one of the most prevalent cancers in Nepal after lung cancer and cervical cancer
• “Every year, the number of breast cancer patients is increasing by 5 percent. Anyone with the family history of any kind of cancer is at high risk of breast cancer,” says Dr Prakash Raj Neupane, Medical Director at Bhaktapur Cancer Hospital (BCH), Nepal in 2017
• Breast cancer is the second-most common malignant disease among Nepali women
• Out of the estimated 3,500-4,000 new cancer patients in Nepal, 200 new cases of breast cancer are being diagnosed every year
• Around 120 patients have undergone breast cancer surgery in BCH in the 2016-17 fiscal year
• Women in the age groups of 40-45 years and 60-65 years were found to be suffering from breast cancer across the nation
• The revelations also indicate risks of breast cancer among men. Men also need to remain aware as cancers are genetic
• Men aged above 60 years were reported to be suffering from such cancer.
• For early detection of the disease, doctors advise public to go through a mammogram test after crossing 21 years to check if there is any lump formation under the skin.

 

 
Let’s unite against Breast Cancer – A 2018 Initiative
On October 13, 2018, people got together at Kathmandu and held a rally with the theme “Let’s unite against breast cancer”. Hundreds of people including women, girls, cancer survivors & celebrities participated in the event organized by Nepal Cancer Relief Society (NCRS) and Bhaktapur Cancer Hospital. They shared knowledge about the risk factors, disease, treatment methods and prevention of breast cancer.