The stigma of breast cancer in developing countries, particularly in women living in poorer communities, is having a profound impact on treatment and survival. Dr Zeba Aziz from the Allama Iqbal Medical College in Lahore, Pakistan, has been comparing the outcome of 286 women with breast cancer based on their socio-economic status.
"Poorer people are not seeking help and do not have easy access to care," said Dr Aziz, speaking at the European Society for Medical Oncology Congress today (21 October 2002). For them breast cancer carries a stigma that greatly lowers self-esteem. This results from both sexes viewing women as sexually unattractive. Emotional and physical abandonment is a common end result. Gross ignorance also leads to breast cancer being considered contagious. "We have seen women being isolated to the point of not being allowed to touch their children or use the household utensils," she said.
The study analysed the size of the tumour, the time of diagnosis, the treatment and survival over three years, until April 2002. Early breast cancer was seen in nearly three-quarters of the women in high socio-economic status and 89% received adequate treatment. In contrast, nearly half the women from poorer, less educated backgrounds did not seek medical help until the cancer had reached an advanced stage, and only 44% received adequate treatment. This resulted in an overall survival rate at 10 years of three-quarters (73%) of women in the high socio-economic status, half (49%) in the middle tier and less than one quarter (22%) in the lower group.
Literacy or ignorance plays an important part in how people manage their illness. There is less stigma attached to women from better-educated sectors. Treatment is unaffordable for many people. Only one-tenth of the population has healthcare insurance. Many women use alternative therapies, including homeopathy and faith healing to avoid surgery. Dr Aziz, who works in one of the major referral centres in Pakistan, often sees women with advanced breast cancer from remote villages, where there is a great variation in the standard and methods of treatment.
Because of the stigma attached to breast cancer, many women deny their condition, believing that a painless lump is nothing to worry about. In fact, some local general practitioners are unaware of the dangers of breast cancer, adding to the delay in early diagnosis and adequate treatment.
The study confirms Dr Aziz's observations of the link between socio-economic status and the outcome for women with breast cancer. "We were not surprised by the conclusions but until now we had no proof." Educating people, including health professionals, is a vital tool in the fight against cancer. It is important also for women to participate in trials. "We urge women to put the stigma aside and seek medical advice early, in order to avoid surgery to remove their breast. Ultimately, many more lives could be saved," she said.