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.

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Indian Prime Minister Narendra Modi began his 2-day visit on Friday with the aim to strengthen the bilateral cooperation between India and Nepal. Despite being Modi’s 3^rd visit to Nepal, this visit is the first ever ‘High Level’ visit from India since Nepal’s new government formation.

The visit came after Nepali Prime Minister, KP Sharma Oli’s visit to India. It focuses on the initiative taken by India towards building friendly relationships with Nepal. Addressing the media earlier, Modi said, “My visit closely follows the State Visit of Prime Minister Oli to India last month. These high-level and regular interactions reflect my government’s commitment to the ‘Neighborhood First’ policy, in consonance with the motto of ‘Sabka Saath, Sabka Vikas’.”

Narendra Modi was received by the Nepal Defence Minister Ishwor Pokharel and Chief Minister of Province-2, Lalbabu Raut among other important persons. Following this, Modi was welcomed with local music and a group of dignitaries in Janakpur.

Visit to Janaki Temple

 Modi then visited the Janaki temple in Janakpur where he offered prayers in accordance with Khodasopachar rituals. The 30-minute puja was administered by 12 priests and was attended by Nepali PM, KP Oli as well. The statue of Goddess Sita is decorated with clothes and jewels as part of the ritual. The Janaki temple is dedicated to the Goddess Sita and is reflects the Hindu Koiri Nepali architecture.

Tradition has it that the special ritual is performed only on behalf of the special guests visiting the temple.

Thousands of people from India and Nepal gathered to see the Indian PM in Janakpur. Once outside the temple, Modi described his experience saying, this is a historic moment. “It is my privilege to come here and offer prayers to Mata Janaki”. Thanking KP Oli, Narendra Modi addressed him as ‘Mere Bhai Sahib’.

Indo-Nepal Bus Route

The Indian PM was welcomed by a civic reception at the Janakpur Sub-Metropolitan City in Barhabigha ground. Talking about the bus route between Janakpur and Ayodhya, he said, “Tourism is developing at a fast pace across the world. This Ramayan Circuit has immense potential.”

During his talk, Modi announced that Janakpur and its surrounding areas would receive a grant of 1 billion for its development.

Following his public addressing, Prime Ministers Narendra Modi and KP Oli flagged off the Ayodhya-Janakpur bus service. Now a part of the Ramayan Circuit, the bus route will connect the birthplaces of Goddess Sita and Lord Ram.

After a spiritual experience and the inauguration of the bus-route at Janakpur in the region of Mithila, Modi was flown to Kathmandu, the capital city of Nepal.

In Kathmandu, Modi was met by Foreign Minister of Nepal, Pradeep Gyawali followed by a ceremonial reception that included a Guard of Honor. Later in the day he met President of Nepal, Bidhya Devi Bhandari and Vice President, Nanda Bahadur Pun.

After the meetings, there were bilateral talks between KP Oli and Narendra Modi. The Nepali Prime Minister then hosted a dinner in honor of the Indian PM.

Modi’s Gift to Bhaktapur Cancer Hospital

Prime Minister, Narendra Modi, also announced that the Indian government would gift Bhabhatron Radioactive Cobalt-60 teletherapy machine to Bhaktapur Cancer Hospital in Kathmandu. This machine will benefit thousands of cancer patients waiting for treatment in the Himalayan nation.

Currently, the Bhaktapur Cancer Hospital in Kathmandu has only one Bhabhatron Radioactive Cobalt-60 telepathy machine. “The hospital was in need of radiotherapy machine for treatment of cancer. There is only one Cobalt-60 radiotherapy machine in the hospital and additional gift would help provide timely treatment to cancer patients,” said Ishwor Shrestha, Director at Bhaktapur Cancer Hospital.

Visits to Muktinath and Pashupatinath

On the morning of 12^th May, Modi visited the Muktinath Temple in the Mustang district of Nepal. The Indian PM offered prayers at the golden statue of Lord Vishnu known as Mukti Narayan at the temple.

Seated at the foot of Thorong La mountain pass, Muktinath is located at a height of 3,710 M. The temple is sacred to both Hindus and Buddhists.

The Muktinath-Chumig Gyatsa houses all the elements, earth, air, holy water and natural fire. Hindus believe that the natural fire and holy waters represents Brahma. The central belief of the Muktinath area is the veneration of Lord Vishnu in the form of Ammonites (shilas) called Salagrama-Shilas.

Modi was then welcomed with a civic reception amidst the beating of drums. He actively participated in the festivities and was seen beating a traditional Nepali dhol.

Later, in the day he visited the famous Pashupatinath temple in Kathmandu. The temple is sacred to Hindus and is located on the banks of Bagmati river. Regarded as one of the oldest temples, the Pashupatinath is the temple of Shiva. Modi has visited this temple in the past but what makes this visit special is that the Indian PM becomes the first leader in the world to visit this holy shrine.

After his visit, he was invited by the President of Nepali Congress and former Prime Minister Sher Bahadur Deuba and other members of the Nepali Congress.

As part of his itinerary, Modi met Communist Party of Nepal (MC) Chairman, Pushpa Kamal Dahal ‘Prachanda’. He was the former Prime Minister of Nepal. The meeting had Modi and Prachanda discuss ways of strengthening bilateral relations.

He also met Mahanta Thakur, President of the Rastriya Janata Party – Nepal, and other leaders of the party. Modi congratulated the party for their electoral performance and exchanged views on deepening the nations’ bilateral relations.

The Indian Prime Minister was honored in a civic felicitation program in the Rashtriya Sabha Griha, Kathmandu. After the ceremony, Modi was presented with a key of the city and other souvenirs by Bidya Sundar Shaka, Mayor of Kathmandu.

Foundation for 900-MW Hydroelectric Power Plant Laid

Modi was privileged to join his counterpart K P Sharma Oli in laying the foundation stone of the 900-megawatt Arun III Hydroelectric Power Plant in Tumlingtar area.

The project was initiated after permission was granted in accordance with the decision of the 30^th Meeting of IBN’s Board of Directors.

The largest capacity Hydroelectricity project, Arun III will be constructed over the next 5 years.

The Satluj Jala Vodyut Nigam Power Development Company was recently granted a license by the IBN, to generate power from the Arun III Hydropower Project. This power development company is a subsidiary of the Indian government-run Satluj Jal Vidyut Nigam Ltd.

The Promise of a Golden Tomorrow

On Sunday, Nepali Prime Minister K. P. Oli addressed the Parliament and gave a brief about the Indian Prime Minister’s, 2-day state visit by Indian Prime Minister Narendra Modi.

He said that Modi had helped take Nepal-India ties to a higher level. Speaking further, he said Indian PM Modi had decided to set into action, the past pacts that were long pending. The two prime ministers have agreed to set a time frame to implement the past pacts.

Oli and Modi also discussed ways to address the trade issue between the two nations, further enabling the easy import of Nepali products like ginger and cardamom.

Oli told the parliament that India was open to the idea of mapping four new air routes. India is willing to extend its support by sending technicians to study Nepal’s proposal for the new air routes and will make a firm decision for the same by September.

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