Pakistan has the highest rate of breast cancer in Asia, and trends suggest that this is likely to increase unless more is done to remove barriers to early screening.
According to the World Health Organization (WHO), nearly 26,000 women in Pakistan were diagnosed with breast cancer, and over 13,500 women died of the disease, in 2020.
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.
Globally in 2020, there were were 2.3 million women diagnosed with breast cancer and 685,000 deaths, according to the WHO.
How can cancer screening be taboo?
Cancer experts emphasize that early screening is critical to preventing serious cases of breast cancer.
However, in Pakistan, some women do not share their health issues with others and are too shy to go for any kind of breast examination, according to research by Shaukat Khanum Cancer Research center.
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 database BMC Women's Health, women in Pakistan 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% of breast cancer patients in Pakistan are diagnosed in the late stage and 59% 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.
According to a recent study on breast cancer in Pakistan cited in the journalCancer Management and Research, Pakistani women "wasted time" using alternative medicine, ignored painless lumps in the breast, and would delay seeking treatment because they consider the breast a "secret organ."
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 many 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 said.
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.