It is more than two years. Nighat Baba still trembles looking at the empty space and a huge scar left after her breast removal. She has been wearing a breast prosthesis to “look normal” but is unable to come to terms with her condition yet.
For 34-year-old Baba, her life changed in 2018 when she suddenly started to feel a hard lump on her left breast. After the examination was done, the doctors at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) suggested to go for Fine Needle Aspiration Cytology (FNAC), a diagnostic procedure where a needle is inserted into the body and a small amount of tissue is sucked for examination under a microscope.
A few days later, her husband was informed that there was a tumor formation in her left breast. Soon after, Baba, a resident of the Lal Bazar area of Srinagar, was admitted to SKIMS where her surgery was conducted. While the doctor had decided to remove the tissues containing the tumor, it was found out that cancer had spread to her entire breast.
“The doctor convinced me to go for the surgery. I just kept requesting her to save me,” said Baba, who broke down in tears recalling the conversation.
During the surgery, the doctors had tried to save Baba’s left breast and just remove the tumor but due to sheet-like formations inside her breast, she was told that her breast was beyond saving. Soon after, her entire breast was removed.
According to the latest figures compiled by the Regional Cancer Centre at the tertiary care Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Srinagar’s Soura, a total of 4,737 cancer cases were reported in the year 2021, up from 3,840 cases in 2020. Lung and breast cancers now account for most of the cases. Alarmingly, Kashmir has a higher death rate of breast cancer patients than that of the rest of India, as per research studies. Breast cancer is the second leading cancer after esophageal cancer in Kashmiri women, with an incidence rate of 12.6 per 100,000. Women in Kashmir are generally diagnosed at a later, more advanced stage with a poor prognosis.
‘I was ready to die’
The first thing that Baba was told after gaining consciousness was that her breast had been removed. She soon started to feel the stitches from the intermammary cleft or cleavage to her armpit. “I saw myself for the first time without my left breast while my dressing was being changed. You don’t remain like a normal woman once your breast is removed,” she said.
The surgical procedure was followed by two cycles of chemotherapies, a drug treatment that uses powerful chemicals to kill fast-growing cancerous cells in the body. Each cycle included four therapies, each after a break of twenty-one days.
Her family and the doctors kept preparing Baba for the side effects of these therapies while she continued losing all her hair, eyebrows, and even her eyelashes. “Eventually I had to accept it. What other options did I have?” she asked.
The removal of her breast and the therapies soon started to take a toll on her mental well-being. Baba started to believe that nothing could save her anymore. “The surgery was really painful but the therapies were worse,” she said. “I was ready to die.”
A financial burden
Recent research, “Lived experiences of women suffering from breast cancer in Kashmir: a phenomenological study”, suggests that many women suffering from breast cancer belong to lower-income groups and face a lot of problems in managing the cost of the treatment. “In a few cases, where women belonged to impoverished families, the treatment was delayed, and firstly, they turned to faith healers to get the cure,” it read.
Farhana (name changed), a 42-year-old woman from Srinagar was diagnosed with breast cancer about three years ago after she started to feel a hard lump around her breast. Unlike Baba, Farhana’s family could not afford the treatment or even the tests at any private laboratory. “She was taken to SKIMS where she got the appointment for the tests about a month later, though her condition worsened during that time,” said her father Bashir Ahmad, who is a vegetable seller.
Farhana’s husband is also a vegetable seller but couldn’t afford to look after her treatment and therefore, she has been living at her parents’ home for the past three years, completely looked after by them along with her three children. “After the tests were finally done, the doctors said that her cancer has spread to other parts of her body as well,” he said.
Ahmad earns about 15000 rupees from his vegetable stall a month and everything goes into the treatment of his daughter. “I had to take out loans to get her treatment done. It hurts me to even think of it,” he said.
Till now, Farhana has gone through thirty-six chemotherapies. The little amount of money that her father had saved for her younger sister’s marriage is now completely exhausted while getting her treatment done. “I don’t know what to do anymore. The medicines, certain tests, and her food cost us a lot. She obviously needs a healthy diet,” said Ahmad.
Over these years, Farhana’s condition has worsened many times and the family had to rush her to the hospital. Ahmad still waits for the day when the doctors decide to conduct her surgery and save her. “I have left it up to God. He will help us,” he said.
Natasha Thakur, Associate Professor in General Surgery at SKIMS and a fellow in the breast cancer department at Grady hospital in Atlanta, said that over the years, she has seen patients overburdened by the cost of treatments. “They usually sell their land because the testing and even the medication is very expensive. A single hereditary test for breast cancer, BRCA1 or BRCA2 costs between 30000-70000 rupees. This is a burden for them,” she informs.
Between hope and despair
Thakur said that there are a variety of symptoms through which a woman can understand that something is not right with her breast including spontaneous nipple discharge, or even bloody discharge, lump in the breast, sudden pain or painless swelling, skin changes, nipple discoloration, nipple excoriation, etc.
When a woman is in the early stage of carcinoma or cancer, the lymph nodes are not always involved, and sometimes, the woman might not even notice a lesion in the breast and just pain in her arm.
“In early-stage cancer, if the tumor is two or five centimeters deep, we say we can salvage the breast because ideally one or two lymph nodes are involved but for those with third or fourth stage breast cancer, a lot of lymph nodes are involved already,” said Thakur. However, in the last stage of metastatic disease, Thakur said that patients often have a fungating region on the breast and therefore, the breast is removed. “So basically, in early breast cancer, the chances of survival and saving the breast are better,” she said.
The procedure is followed by radiotherapies. Depending upon how salvageable the cancer is, surgery is conducted. “Otherwise, chemotherapy is followed by surgery and chemotherapy or radiotherapy. It is like sandwich therapy,” Thakur said.
Over the years, Thakur has analyzed more cases of breast cancer amongst women from rural areas due to the lack of awareness. “Most of these women tell me that they noticed a node long back but it wasn’t hurting so they ignored it,” she said.
In a recent data compiled at SKIMS, Thakur said that it was found out that breast cancer has now taken over all the other forms of cancer. “I get around 3-4 patients with breast cancer every week. One in 28 per cent of females are suspected and after every four minutes, a woman is diagnosed with breast cancer nowadays,” she said, adding that lifestyle changes, food habits, delayed pregnancies, obesity, oral contraceptives, smoking, and alcoholism are some of the major reasons for breast cancer.
“Women should start going for breast examinations soon after they get their first period. Stand in front of the mirror, raise your arm, and feel if there is something pulling the breast. Then see if there is a mark. Apply oil on the breast then examine it with the palm of the hands. In a circular motion, check the breast,” she added.
With advancements in science, there are options like breast reconstruction surgery through which the fat tissues from one part of the body are cut and attached to the breast area to form a new breast. “But having or not having a breast is totally a woman’s choice,” said Thakur.
Nighat Baba decided to go for breast reconstruction surgery after she continued to feel uncomfortable in her clothes. But now she is confused about making the decision due to the constant fear of cancer resurfacing on her other breast. “I think I will have to live with it now,” said Baba. “I just keep checking my right breast to make sure that I don’t have cancer again.”
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