t’s Breast Cancer Awareness Month and doctors say self-examinations could make a huge difference

Most women with breast cancer are diagnosed in late stages because of a lack of awareness of early detection and barriers to health services.

In 2010, when Bishnu Devi Shrestha, a board member at the BP Koirala Memorial Cancer Hospital in Bharatpur, was on a trip to China, she happened to share a room with Dr Tara Manandhar, an oncologist. At night, during a conversation, Shrestha mentioned that she was having problems with her nipple retracting.

“I was lucky to share a room with Dr Manandhar, who suggested that I immediately get my breast examined,” said the 67-year-old Shrestha.

Upon her return to Nepal, Shrestha got herself examined and discovered she had breast cancer. She had to undergo surgery to remove the nipple and a lymph node. After eight cycles of chemotherapy and a month of radiotherapy, she finally got rid of cancer and is now healthy.

“Despite being a board member of a cancer hospital, I hesitated to examine my breast because I’d heard that there would be nipple discharge and pain,” said Shrestha. “Now I ask all women to regularly examine their breast and consult with doctors if they find something unusual.”

Breast cancer, after cervical cancer, is the second leading cause of cancer in women in Nepal. But without early detection and subsequent treatment, after which complete recovery is possible, women in increasing numbers are succumbing to the illness, say doctors.

“Women should examine their breasts regularly, which can help detect cancer in the early stages,” said Dr Sandhya Chapagain, an oncologist at Bir Hospital. “Most patients come in for treatment in the third or fourth stage of cancer when the condition is already more complicated.”

The World Health Organization marks October as ‘breast cancer awareness month’ and has urged its member countries to launch activities to make women aware of the need for regular examinations. For the past three weeks, cancer hospitals, oncologists and several other organisations have been organising programmes around the country to raise awareness about breast cancer. According to the UN health agency, the majority of deaths occur in low- and middle-income countries, where most women with breast cancer are diagnosed in late stages due primarily to a lack of awareness about early detection and barriers to health services.

Nationwide data on the number of people diagnosed with cancer each year in Nepal is currently unavailable. But that might change soon. Since January 2018, the Nepal Health Research Council has been working to create a national cancer registry, which is expected to be completed soon.

“We were taught that breast cancer generally happens after 40 years of age but we’ve found that more young women are suffering from the disease,” said Chapagain.

Breast cancer doesn’t have an exact cause but an increase in the use of tobacco, alcohol and unhealthy food, and pesticides in vegetables and fruits are some of the reasons behind the rise of breast cancer in young women, according to doctors.

According to Bijaya Chandra Acharya, executive director at the BP Koirala Memorial Cancer Hospital in Bharatpur, 11,130 women visited the hospital’s out-patient department to get their breasts examined in 2018. Among them, 288 underwent cancer surgery while others received chemotherapy, radiotherapy and hormone therapy, according to the hospital. Breast cancer in males is rare but 79 men were diagnosed with the disease and received treatment in 2018 at the hospital.

Breast cancer can be treated if it is diagnosed in the early stages and people can lead normal lives. But the lack of awareness and knowledge about self-examination means many people miss out on a better chance at recovery.

“We have been running regular classes for our patients to teach them self-examination techniques,” said Acharya. “We also organise regular camps in several districts to screen breast cancer patients.”

Doctors say breast self-examination and regular visits to the doctor to check for lumps in the chest are key to detecting cancer in its initial stages. Women should immediately go to the hospital if they find a lump or a hard knot in their breasts, and should look for signs of unusual change in breast size and shape, or discharge from the nipples, Acharya said.