Explained: How Pakistan's patriarchy raises breast cancer risks

Many women in Pakistan are reluctant to get screened early because of social taboos about female bodies.

A hospital in Karachi organized a breast cancer awareness walk last year.

Pakistan has one of the highest rates of breast cancer in Asia, and trends suggest that this is likely to increase unless more is done to remove barriers to early screening. An estimated 40,000 women die each year in Pakistan from breast cancer, and 83,000 are diagnosed with the disease, according to the Shaukat Khanum Research Center in Lahore.

Health care experts attribute this high mortality rate to lack of screening and treatment centers. Although setting up better health facilities is an important step, social factors are also contributing to Pakistan's breast cancer problem. Some women do not share their health issues with others and are too shy to go for any kind of breast examination, according to Shaukat Khanum's research.

How can cancer screening be taboo?

Breast cancer specialist at Islamabad Polyclinic hospital Erum Khan said Pakistan's patriarchal culture and taboos over women's bodies were primary factors behind late breast cancer diagnosis. She told DW that some women are taunted when they seek diagnosis and treatment. In one instance, a patient was driven to tears explaining how her husband said she had "become a man" after her breasts were removed in life-saving surgery.

"Married women think that if their husbands learn about this disease, they might marry another woman," Pakistani women's rights activist Mukhtaran Mai told DW . "The unmarried believe just going to seek diagnosis could scupper their chance of finding a man," she added.

According to a study published in the online journal BMC Women's Health, an online database of scientific articles, early screening has a significant impact on preventing serious cases of breast cancer. In Pakistan, women are more likely to feel stigmatized when seeking early treatment, especially in cases when dealing with male doctors would be the only option.

The study also cited age, employment status, lack of awareness, fear of surgery, and belief in traditional treatments, and spiritual healing as contributing factors. As a result, 89 per cent of breast cancer patients in Pakistan are diagnosed in the late stage and 59 per cent at an advanced stage, the study said.

Khan said recruitment of more female breast cancer specialists, more awareness campaigns at female colleges and training of gynecologists and female health workers are all needed to help more women in Pakistan survive breast cancer. Khan added that there is also a misconception among women that surgery is the only option when diagnosed with breast cancer. Many do not know that, in the first and second stages, surgery may not be needed at all, she said.

Ignorance is 'killing women' in Pakistan

Waheeda Nayyar, 50, was diagnosed with breast cancer two years ago, and she was able to get treated in time to control its progression. She told DW that the majority of Pakistani women are not as lucky. Ignorance, superstition and cultural factors are killing women, she said.

"I came across many women who did not want to be physically examined because of hesitation and shyness," said Nayyar, a resident of the southern port city of Karachi. "Many women from less developed areas of the country who came to be treated were at an advanced stage," she added. "When I asked them the reason for the late diagnosis, they said they had felt shame" in talking about breast cancer, she noted.

Nayyar's daughter, Nimra, who frequented the cancer hospital where her mother received treatment, said rural women had told her that they "could not have imagined telling their male relatives about this disease." "In our case my mother informed my brother and me," she told DW . She said many stage 3 breast cancer patients she met said they did not have any female family members with whom they could share their concerns. "They felt ashamed talking about this with their sons or other male family members," she said.

Superstition trumps science in rural areas

Women's rights activist Mai said she lost her 46-year-old sister-in-law to breast cancer earlier this year. Mai's sister-in-law had been reluctant to see a male doctor to talk about breast cancer, and then it was too late, she said. In many cases, Mai said, women in rural Pakistan seek advice from religious clerics, who advise them not to go to male doctors to be examined for breast cancer. This delays diagnosis until it is too late for effective treatment. "We were also advised not to go to doctors or seek surgery," Mai said.

Mai ended up bringing her sister-in-law to seek treatment, but the reluctance to seek an early diagnosis ended up costing her life. Mai added she knew of at least six women from her area who were advised by doctors to get a breast cancer biopsy, but are reluctant to do so. "Talking about breast cancer is a taboo in our society," she told DW .

Another young woman in rural Punjab who spoke to DW on condition of anonymity said a cleric in her town told her not to go to the doctor after she experienced acute pain in her breast. She said going to a male doctor made her feel "ashamed" and would have felt more comfortable going to a female physician.