Aggressive Behavior of Breast Cancer in Pakistan Needs Attention

2026-02-04 - 00:06

Dr Nabila Javed Director Dera Ismail khan institute of nuclear medicine and radiotherapy (AECH DINAR Breast cancer is the leading malignancy among females, not only globally but also in Pakistan. It is the second most common cause of cancer-related deaths in developed countries, after lung cancer. Unfortunately, Pakistan has the highest incidence of breast cancer among South Asian countries, with approximately one in every nine women having a lifetime risk of developing the disease. Around 90,000 new cases of breast cancer are diagnosed annually, and a significant proportion of patients succumb to this disease. The high mortality rate is largely attributable to the fact that more than 70% of cases are diagnosed at advanced stages due to cultural barriers, lack of awareness, fear of stigma, and limited access to screening facilities. The likelihood of survival diminishes significantly when breast cancer is diagnosed at later stages. Risk factors for breast cancer in Pakistan include increasing age, socio-economic factors, early marriage, late menopause, obesity, self-medication such as the use of hormonal drugs for child spacing, and delayed diagnosis. According to a study conducted in collaboration with Khyber Medical University, Peshawar, it was revealed that 67% of breast cancer patients presented in advanced stages (IIB–IV). The median age of presentation was in the fourth decade of life, whereas in the United States it is approximately 62 years, and only about 5% of cases present below the age of 40 years. Similarly, 67% of patients in Pakistan presented at advanced stages compared to only 17% in the USA, which is a striking difference and underscores the importance of breast cancer screening. Furthermore, the Pakistani population exhibited several poor prognostic factors, including fewer hormone receptor–positive cases and more than twice the proportion of HER-2–positive tumors, indicating aggressive disease biology. Overall, the clinical behavior of breast cancer in Pakistan appears to be highly aggressive. The Pakistan Atomic Energy Commission (PAEC) has been providing radiation-based healthcare services since 1960 under its mandate for the peaceful, safe, and secure application of nuclear technology. PAEC has established twenty-one (21) Atomic Energy Cancer Hospitals (AECHs) across the country, providing diagnostic and treatment services to more than 80% of cancer patients in Pakistan. These centers are equipped with state-of-the-art facilities, including LINACs, X-ray units, mammography, digital simulators, DEXA scans, SPECT and SPECT-CT, CyberKnife, CT simulators, cyclotrons, brachytherapy units, MRI, and CT scanners, along with advanced laboratory facilities for early and accurate diagnosis. Most patients at these hospitals receive free treatment through the Sehat Sahulat Card or financial assistance from Patient Welfare Societies. In addition to treatment, all AECHs are actively involved in cancer awareness campaigns, particularly for breast cancer. The month of October is observed as Breast Cancer Awareness Month at these hospitals. During this period, AECHs organize symposiums, seminars, awareness walks, and free breast cancer screening clinics, where ultrasound and mammography services are provided at no cost. Awareness sessions are also conducted at colleges and universities to promote knowledge of screening tools essential for early detection. Male participation is encouraged, as breast cancer can also occur in men, although its prevalence is approximately 1%. Furthermore, AECHs disseminate awareness messages through Radio Pakistan in regional languages to ensure wider understanding. Print and electronic media are also engaged to maximize outreach. Some AECHs operate mobile mammography units to serve areas lacking mammography facilities. All AECHs recognize their responsibility not only to treat cancer patients but also to create public awareness about various cancers, particularly breast cancer. They remain committed to the early detection of breast cancer, which enables cost-effective treatment and helps preserve vital organs, thereby improving quality of life. Moreover, factors such as younger age at presentation, advanced stage at diagnosis, high tumor grade (G-III), and other poor prognostic indicators necessitate prompt public health interventions to investigate and address the aggressive nature of breast cancer in Pakistan.