As breast cancer emerges as the most rampant malady among women in Kashmir, Babra Wani met some survivors and treating oncologists to offer a narrative about the prevalence, management and post-survival crisis
At 52, Safiya, a resident of South Kashmir, faced a traumatic July in 2018. The nightmare unfolded when a doctor broke the shocking news to her: “You are suffering from breast cancer.” Even today, the echo of that sentence sends shivers down Safiya’s spine, her eyes welling with tears as she recalls the moment.
The impact was not exclusive to Safiya alone; her family, including her husband and three children – two daughters and a son, grappled with the shocking news. “We could not, for a few moments, comprehend what was being revealed to us,” Safiya’s eldest daughter vividly describes the initial disbelief. “I still remember feeling needles all over my body. Never in my wildest dreams had I imagined that my mama would be diagnosed with cancer. For a second, I thought I had lost my mother.”
Acknowledging the profound difficulty of that phase, Safiya lamented, “No doubt it was a challenging period. But Alhamdulillah, that phase passed too. I was particularly worried about my children; they were too young and dependent on me. Throughout my treatment, throughout those years, I prayed every day for my better health, for the sake of my family, and for my own sake too. Those years were marked by constant fear and apprehensions.”
Last year marked Safiya’s declaration of being cancer-free, and since then, she has been striving to lead a normal life. In Kashmir, however, Safiya’s story is far from isolated. Numerous cases, as revealed by studies over the years, underscore the prevalence of breast cancer among the women of Kashmir, providing a poignant testament to the enduring suffering of women in the region. “It is the lung cancer that is top killer among men in Kashmir,” Dr Sheikh Aejaz, a senior consultant who earlier headed the SKIMS’s Oncology department said. “Among women, it is the breast cancer that kills.”
The Numbers
In a 2016 study titled Epidemiology of Cancers in Kashmir, India: An Analysis of Hospital Data, however, Mariya A Qureshi revealed that, in terms of frequency, colon cancer (16.8 per cent), breast cancer (16.1 per cent), and stomach cancer (10.4 per cent) ranked as the most common cancers among females.
A subsequent 2021 study, Cancer Scenario in Kashmir – A Study Conducted in a Tertiary Care Centre, Srinagar, Kashmir conducted by Dar Abdul Waheed et al underscored that among females in Kashmir, breast cancer stood out as the most prevalent.
Adding to the study titled Epidemiological Studies on Breast Cancer in Kashmir Valley” by Natasha Thakur et al highlighted that in India, breast cancer ranks as the second most frequent cancer among women, constituting one-fifth of all cancer types in Indian women and approximately seven per cent of the global breast cancer burden. However, within Kashmir Valley’s female population, breast cancer has witnessed a surge, now standing among the most widespread cancers.
At the Sher-I-Kashmir Institute of Medical Sciences in Soura, Srinagar, the study documented 226 confirmed cases of breast cancer among women. Of these cases, approximately 66 per cent presented with the local-stage disease, 28 per cent with regional-stage disease, and six per cent with distant (metastatic) disease.
The study further unveiled that breast cancer incidence increases with age, ranging from 19 to 78 years old, with the majority of cases (46.02 per cent) originating from South Kashmir, followed by patients from North Kashmir (31.86 per cent) and Central Kashmir (22.12 per cent). Notably, the majority of women diagnosed with breast cancer had early menarche, beginning at age nine (58.41 per cent).
Dr Manzoor Ahmed Bhat, the Head of the Department of Radiation Oncology at Government Medical College Srinagar, noted a shift in the prevalence of cancers over the years, including breast cancer, lung cancer, and colon cancer. “Previously, these cancers were thought to be exclusive to the affluent society, but now we are seeing these cancers due to changes in our lifestyles,” he observed.
Warning Signs
While the escalating number of breast cancer cases is indeed alarming, it is crucial to acknowledge that the disease doesn’t strike without signalling its presence. For Safiya, the first inkling came in the concluding week of June when she sensed a change in her right breast. “My right breast felt a bit sore, and I could sense that something was wrong. Initially, my instinct was to ignore it,” shared Safiya, a former educator. “But as the pain intensified beyond tolerance, I consulted a gynaecologist who advised a series of tests.”
Dr Manzoor emphasised the familial link in most cancers, stating, “Breast cancer is one such with a familial connection. If, for instance, a mother has breast cancer, there’s a good chance her daughters or sisters may also be at risk, given the genetic nature of cancer.” Outlining various warning signs crucial for early breast cancer detection, he said: “Women with breast cancer typically notice a swelling when they feel the breast—usually a disease of the elderly, prevalent after 40. However, it’s not exclusive to older age; occasionally, we do see it in younger females. The common indicators include a lump or swelling felt under the fingers, nipple discharge, changes in breast shape or contour, and sometimes, swelling in the armpit.”
Safiya embarked on a long and exhausting journey of treatment following the detection of her breast cancer.
Detection and Treatment
Oncologists outline three primary modalities of cancer treatment: chemotherapy, surgery, and radiotherapy. “The choice depends on the patient’s condition, the type of cancer or tumour, and the available facilities,” Dr Manzoor explained. The pivotal factor is the accurate detection of the disease through tests like a biopsy, emphasising the importance of confirming cancer before initiating any treatment.
Usually, the doctors from the surgical and non-surgical sides sit and discuss the cases on a case-to-case basis. In certain cases, they always keep the radiotherapists in the loop. “We form plans and proceed with treatment only after confirming the diagnosis and staging. After surgery, we assess whether radiotherapy or chemotherapy is necessary and initiate accordingly,” Dr Manzoor said. It is very crucial decision-making to decide if the patient needs surgery first or chemotherapy or vice versa. Following completion of treatment, patients undergo regular follow-ups, a process Dr Manzoor describes as “prolonged,” emphasising the need for ongoing observation.
Managing cancer has always remained a very capital-intensive exercise that drains the families of their savings and emotions. Off late, however, cancer treatments have become a bit cheap, thanks to health schemes like the Ayushman Bharat scheme. Still, the patients have to manage most of the financial burden of drugs and post-surgery requirements. In the private sector, however, the scheme hardly matters.
Admitting that cancer management is still very expensive, especially in the private sector, Dr Aejaz however, flagged the changes that he witnessed in the last decade. “At one stage, the medicine would cost a fortune but the arrival of biosimilar drugs manufactured by the pharmaceutical companies in India has drastically impacted the costs in certain cases,” Dr Aejaz said. “The emergence of immunotherapy is very impressive and in certain cases, it has fundamentally altered the treatment line and outcome.”
Oncologists admit that the cure is possible if the disease is detected early. Proper cancer screening, including regular and area-wise screenings, is crucial, they assert. “Now there are very efficient drugs, some of which are helping a great deal in extending the lives of seriously sick patients,” Dr Aejaz said.
Dr Manzoor advises females to engage in monthly Breast Self-Examination (BSE), emphasising its simplicity and importance. “Every female should routinely perform BSE after a monthly bath, feeling for any abnormalities,” he said. “If anything is felt, a doctor visit is the next step, followed by mammography or ultrasound if necessary.”
Safiya’s case mirrors this process. Her surgery, a necessary step in curing her disease, took an emotional toll. Dr Manzoor explains two surgical options: Breast-conserving surgery (BCS), where only the swelling is removed, and mastectomy, where the entire breast is removed. He notes the emotional impact of mastectomy, stating that the chosen procedure depends on a set of factors.
Identifying lifestyle and obesity as potential contributors to breast cancer, Dr Manzoor advocates for a healthy lifestyle. Rahat, like Safiya, underwent surgery for breast cancer. Recounting her experience, Rahat highlights the emotional burden, underscoring the need for support and resources for those facing such challenges.
Psychological Impact
Rahat vividly recounts the toll her battle with cancer took on her, both emotionally and physically. “Sleepless nights, anxiety, always questioning why me?” Rahat reflects, highlighting the emotional roller coaster she endured. Denial is usually the first response from a patient and the moot point remains – no, and then, why me? Besides the conventional treatment, Rahat sought support from psychiatrists and psychologists to cope with overwhelming anxiety and persistent sadness. In evolved societies, a psychologist is part of the team that manages the patient.
Safiya, echoing Rahat’s sentiments, acknowledges the emotional and psychological weight of her disease. “You have lived with a body your entire life, and then suddenly, a disease snatches away a part of your body and a part of you. How traumatising is that?” Safiya remarks, her voice carrying the weight of her experience. She further reveals grappling with body image issues, stating, “There were times when I thought of stuffing my chest, as my feminine standards were compromised. My identification as a female was altered.” In certain cases, they report phantom pain, an imaginary pain they report in the breast that no longer is there.
Dr Yasir Rather, a Professor in the Department of Psychiatry at IMHANS, GMC Srinagar, acknowledges the spectrum of emotions women diagnosed with breast cancer can face. “Fear, anxiety, and persistent sadness are common responses. The uncertainty of the future and concerns about treatment side effects contribute to psychological distress,” he notes. Dr Rather emphasises that body image issues may arise due to surgery or changes in appearance, impacting self-esteem. “Fertility concerns, especially for younger women, can also add emotional strain,” he said. “The persistent fear of recurrence and coping with potential loss further influence psychological well-being.”
