ancer remains one of the leading causes of death across the world. It was responsible for nearly 10 million deaths in 2020 - about one in six, globally. The most common cancers include breast, lung, colorectal and prostate cancers. In 2022, breast cancer caused an estimated 670,000 deaths among the 2.3 million women diagnosed with the disease. Pakistan lacks a central registry, however. 44 percent of deaths were reported annually in approximately 90,000 women diagnosed each year. Pakistan Atomic Energy Commission’s Nuclear Medicine and Oncology Division operates 17 cancer institutes around Pakistan. The most recent data covers the timeline from 2015 to 2019. The most vulnerable age group was 40-69 years. Nearly two out of five women had the disease. The highest number of breast cancer cases was seen in the Punjab, the reason being more awareness and easy accessibility to diagnostic services. A 2016 study (Majeed A; Annals of PIMS; 2017) in rural Punjab found that the most common types of cancer were invasive ductal carcinoma of breast tissue, followed by lobular carcinoma.

According to the World Health Organisation, some of the known risk factors of breast cancer include being female and increased risk with age, obesity, alcohol use and tobacco use. One noted fact was having a family history. Women whose mothers, aunts or sisters have had breast cancer have an increased risk of developing breast cancer, especially mutations in the BRCA1, BRCA2, and PALB-2 genes. Radiation exposure history was also noted as a factor. Reproductive history, e.g., age at first pregnancy, timing of menstrual periods, as well as use of postmenopausal hormone therapy. Nearly half of all cases occur in women who have no known risk factors aside from being female and aging. It is important to note here that breast size does not affect cancer risk. However, women who have already had breast cancer have a slightly higher chance of developing cancer in the other breast.

In most women, breast cancer first appears as a breast lump. Other signs include shape or skin changes, nipple discharge, inversion, rash, arm swelling or armpit lump. Early detection is crucial. The breast lump occurs when abnormal breast cells grow uncontrolled, forming tumors. These may begin in the milk ducts or lobules of the breast. An in situ cancer means it hasn’t invaded surrounding tissue. Once it invades, it’s considered invasive. Cancer cells can spread to lymph nodes and other organs (metastasis). Changes in breast size, shape or appearance must also be mentioned: skin changes (dimpling, redness, pitting); changes in the nipple or surrounding skin and abnormal or bloody discharge from the nipple must also be reported by female patients.

Patient-related factors - such as fear, neglect and financial constraints—are more significant than physician or system-related delays. There is an urgent need for breast cancer awareness and culturally sensitive education campaigns to reduce fear and encourage early medical consultation. A cross-sectional study (Habibullah S; PJMR 2016) focused on a major public sector hospital, giving insight into the challenges of Pakistan’s healthcare system for women of low socioeconomic status. The study confirmed that patient delay is the predominant factor in diagnostic delay of breast cancer in Pakistan. Fear of diagnosis, lack of awareness and financial constraints form a triad of major barriers.

These findings align with global evidence from other low- and middle-income countries, where sociocultural and economic factors outweigh system inefficiencies in causing delays. Interestingly, younger women (18–25 years) were more likely to delay diagnosis—possibly due to denial, social stigma, or perception of being “too young” for cancer. Conversely, healthcare provider and institutional delays were relatively minor, indicating reasonable medical responsiveness once the patient seeks care.

Zaheer et al. BMC Public Health (2019) observed data collected from three major tertiary care hospitals in Karachi, Jinnah Postgraduate Medical Centre (JPMC), KIRAN and Civil Hospital Karachi. A total of 9,771 female cases (ages 15+) were analysed. Previously, women aged 60-64 years had the highest overall breast cancer incidence rates. However, between 2016 and 2025, a substantial rise in breast cancer cases is expected among women aged 50-64 years. The total projected breast cancer incidence is estimated to increase by approximately 23.1 percent in 2020 and 60.7 percent by 2025. Notably, cases diagnosed in younger women - aged 30–34 years - are projected to rise sharply, from 70.7 percent in 2020 to 130.6 percent in 2025.

Breast cancer is detected on a mammogram, initially. A mammogram is a low-dose X-ray of the breast used to detect early signs of cancer, often identifying tumors before they become physically noticeable. When a mammogram appears whiter, it means the breast tissue is denser and composed of more glandular and connective tissue rather than fatty tissue. Dense breast tissue and tumors both appear white on a mammogram, making it difficult to distinguish a lesion or cancerous area from the surrounding tissue. This can lead to missed or delayed diagnoses. To overcome this limitation, 3D mammography is recommended. A 3D mammogram takes clearer, layered pictures of the breast, helping doctors find hidden cancers more accurately and reducing the chance of missed or false results.

Additionally, ultrasound and MRI are being done in tertiary care hospitals. For high-risk women (e.g., those with genetic predispositions like BRCA1/2, or chest radiation at a young age), guidelines call for earlier and more intensive screening, including MRI beginning in mid-20s to 30s, plus mammograms earlier than 40, depending on risk. A retrospective study conducted in 2016 in rural areas around the capital city, Islamabad (Majeed A; Annals of PIMS; 2017), about breast cancer awareness and screening, revealed alarmingly low awareness and limited diagnostic access. Among 5,000 women screened, many cases were detected late, emphasising the urgent need for early detection programmes, mobile screening units and education campaigns. Expanding rural outreach can greatly reduce Pakistan’s rising breast cancer burden. The findings underscore the urgent need for national-scale, prospective screening initiatives combined with public education to reduce breast cancer mortality in Pakistan.

The World Health Organisation Global Breast Cancer Initiative has set the target to reduce 2 percent breast cancer-related deaths per year worldwide. Campaigns like Breast Cancer Awareness Month in October every year, is important as it reminds everyone that early detection through regular self-exams and screening saves lives. It inspires patients to cherish life, support and interact with survivors and remember loved ones who have passed away.

Breast cancer is treated through a combination of chemotherapy and surgery. Chemotherapy usually involves giving three different medicines every one to two weeks for six to eight cycles. It helps shrink the tumor and can reduce the cancer stage (for example, from Stage 3 to Stage 2) making surgery easier and more effective. Surgery remains the main and definitive treatment, as it removes the cancer completely. Sometimes chemotherapy is also given after surgery to prevent the cancer from returning. Even when chemotherapy appears to eliminate the disease, surgery is still essential to ensure full treatment and long-term cure. Radiotherapy is usually given after breast cancer surgery to destroy any remaining cancer cells and prevent recurrence. It’s essential after breast-conserving surgery and may also follow a mastectomy if the tumor was large or had spread to lymph nodes. This final step greatly improves long-term recovery and survival.

Several organisations in Sindh are providing crucial chemotherapy and support services for breast cancer patients. The Cancer Foundation Hospital offers cost-effective chemotherapy under the supervision of qualified doctors and trained nursing staff. Bait ul Sukoon, a free cancer hospital and hospice, provides treatment and palliative care to patients in need. The Patients Aid Foundation, JPMC Karachi, ensures that no woman delays breast cancer treatment due to financial constraints. Pink Ribbon Pakistan is establishing a dedicated breast cancer hospital and offers financial support for chemotherapy through donations. Patients can directly contact The Cancer Foundation Hospital or Bait ul Sukoon to inquire about chemotherapy programmes and eligibility. They may also reach out to Patients Aid Foundation or Pink Ribbon Pakistan for financial assistance. Local charities such as the Cancer Patients’ Welfare Society can also help with treatment-related expenses or logistical support. Together, these efforts aim to make breast cancer treatment more accessible and affordable for women across Sindh.

Organisation for Economic Cooperation and Development 2021 situational analysis in collaboration with the Breast Cancer Subcommittee of Khyber Pakhtunkhwa revealed a severe shortage of diagnostic facilities - only 11 mammography machines are available for the province’s 35.5 million residents, highlighting the urgent need to expand breast cancer screening infrastructure across Khyber Pakhtunhwa.

Until recently, there were no dedicated breast cancer centres in Balochistan. The provincial government has now launched a free cancer treatment programme, marking a significant step forward in accessible cancer care. As part of this initiative, a dedicated ward for cancer treatment has been made operational at Bolan Medical College. Under this programme, cancer patients are being provided with costly injections worth up to Rs 1.3 million free of charge. Furthermore, patients can seek treatment at major facilities in other cities, such as the Pakistan Institute of Medical Sciences in Islamabad or the National Radiotherapy and Oncology Centre. Radiotherapy services are available only in Quetta, Balochistan, primarily through the NORI Atomic Energy Cancer Hospital, which offers advanced external beam radiation and brachytherapy. Other facilities are located in Peshawar at the MINA Atomic Energy Cancer Hospital

Chemotherapy for breast cancer is available at several leading public and private hospitals, but is mainly concentrated in Lahore. These include Shaukat Khanum Memorial Cancer Hospital and Research Center, King Edward Medical University’s Department of Oncology and INMOL Atomic Energy Cancer Hospital. The newly established Pink Ribbon Hospital in Lahore is Pakistan’s first dedicated breast cancer hospital, providing free diagnosis and treatment for deserving patients.

According to the American Cancer Society, when breast cancer is detected early and is in the localised stage, the five-year relative survival rate is 99 percent. As we observe Breast Cancer Awareness Month, let’s turn awareness into meaningful action. Together, we can promote meaningful education, ensure early detection and advocate for accessible, equitable treatment for every woman - regardless of background or income. True progress lies in research, not only awareness. Investing in metastatic breast cancer research will save lives, bring hope and move us closer to ending breast cancer deaths.

The writer is a family physician at Evercare Hospital, Lahore.