Muhammad Muhammad Saad ( Dow Medical College, Karachi. )
Faizan Sheraz ( Army Medical College, Karachi. )
Saad Ullah ( Dow Medical College, Karachi. )
Hasnain Abbas Dharamshi ( Karachi Medical and Dental College, Karachi. )
Madam, Breast cancer is a common cancer worldwide. The age standardized incidence rate for breast cancer in women of Karachi, was 69 and is the second highest rate in Asia.1 We would like to highlight few strategies which general physicians can use to modify risk factors and screen early cases at primary care physician level.
A study conducted in female students of Lahore indicated that information about breast cancer was acquired mostly by television or hearsay.2 Efforts should be made at national level to promote quality educational programmes on television and other sources of media that highlight the importance of screening for breast cancer. With this, a special effort is required to promote education about mammography in our population as even women in higher education institutes are unfamiliar with it. We believe that a joint effort by the government and general physicians is warranted which includes the physician inquiring all female patients of appropriate age about their breast health and dispensing standard government issue information pamphlets in local language to promote awareness.
Encouragement by physicians to exercise and maintain BMI within normal criteria should be top priority. It has been demonstrated in a meta-analysis that for every 5-kg/m2 increase in BMI, an increase in risk of post-menopausal breast cancer by 12% was noted.3 Therefore, maintaining weight within normal BMI limits should be a top-priority for female patients.
Use of hormonal agents for prevention of breast cancer in high risk patients should be considered by general physicians. A study has shown that at health care provider level, doctors often lack information due to lack of time.4 It is well-known that recommendations from doctors have a significant effect on patient choices, focused CME activities by local organizations should be conducted on this topic.
We request that general practicing physicians who are present in such a large number, incorporate these suggestions when taking care of their female patients. A simple approach to changing patient behaviours would be to ask about concerns and risk factors, give relevant advice, assess the severity of problem, assist in any manner possible and arrange for means that will help reduce the risk factors and eliminate this problem at grass root level.
1. Badar F, Faruqui ZS, Uddin N, Trevan EA. Management of breast lesions by breast physicians in a heavily populated South asian developing country. Asian Pac J Cancer Prev2011;12:827-32.
2. Khokher S, Qureshi W, Mahmood S, Saleem A, Mahmud S. Knowledge, attitude and preventive practices of women for breast cancer in the educational institutions of Lahore, Pakistan. Asian Pac J Cancer Prev 2011;12:2419-24.
3. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569-78.
4. Kaplan CP, Haas JS, Perez-Stable EJ, Des Jarlais G, Gregorich SE. Factors affecting breast cancer risk reduction practices among California physicians. Prev Med 2005;41:7-15.