For poor house wife Farmeen Bibi, life in the quiet village of Pabbi in Nowshera district revolved around her children, family and the simple joys of a peaceful home. At 66, she had spent much of her life caring for those around her. But a small, growing lump in her right breast gradually changed the course of her life and eventually claimed it after nearly a year of immense suffering.
A lump, then silence: The hidden cost of breast cancer in KP
By Fakhar-e-Alam
PESHAWAR, Sept 13 (APP)::For poor house wife Farmeen Bibi, life in the quiet village of Pabbi in Nowshera district revolved around her children, family and the simple joys of a peaceful home.
At 66, she had spent much of her life caring for those around her. But a small, growing lump in her right breast gradually changed the course of her life and eventually claimed it after nearly a year of immense suffering.
At first, Farmeen kept the lump to herself perhaps due to fear of society and social stigma surrounding a disease that many women still find difficult to discuss openly in Khyber Pakhtunkhwa. Whatever the reason, precious time was lost and the deadly disease spread to chest.
“Initially, my mother hid a small lump. Once it became larger, she asked my father to take an appointment with a specialist doctor, but by then it was too late,” recalled her younger son, Muhammad Noman Khan, while talking to APP.
By the time Farmeen was examined by an oncology specialist, the cancer had already reached stage three, significantly reducing her chances of recovery.
For almost a year of battle, her family watched her endure the physical and emotional pain of the disease. They hoped that chemotherapy treatment would bring her back to the life instead, the illness continued to take its toll.
Eventually, Farmeen lost her battle, leaving behind grieving children and a family struggling to accept a loss that might have been different had the disease been detected earlier.
For poor Noman, however, his mother’s death represents more than a personal tragedy but a painful reminder of the social barriers that continue to surround breast cancer.
He said his mother’s illness profoundly affected her life and that some relatives gradually distanced themselves from her after learning about her diagnosis.
“The social consequences can be one of the reasons why women remain shy about talking about breast cancer in Khyber Pakhtunkhwa,” he said, expressing concern that women may fear that disclosure of the disease could affect their family relationships and social lives.
For a son who watched his mother suffer for months, the memory has now become a call for change and time to unite against breast cancer.
Noman believed that greater public awareness through print and digital media is needed so that women do not remain silent about symptoms that could potentially save their lives.
He also urged the Khyber Pakhtunkhwa government to establish more cancer hospitals and ensure free or affordable treatment for patients, particularly those belonging to poor and vulnerable families so that no child could be deprived of a mother, sister or wife.
His appeal reflects a wider challenge facing Pakistan, where breast cancer remains a major public-health concern in KP.
According to the World Health Organization, breast cancer is the most commonly diagnosed cancer among women in many countries and remains one of the leading causes of cancer-related deaths among women worldwide. WHO estimates that breast cancer caused hundreds of thousands of deaths globally in 2024.
Importantly, most women who develop breast cancer do not have an identifiable risk factor other than being female and getting older.
Breast cancer can also affect men, although it is far less common.
In Pakistan, doctors said the burden is particularly serious, with an estimated one in nine women at risk of developing breast cancer during her lifetime.
More than 90,000 new cases are estimated to be reported annually, while tens of thousands of women die from the disease each year.
Professor Dr. Mah Munir, Head of Oncology Department at Khyber Teaching Hospital, Peshawar, said women should never ignore unusual changes in their breasts and should seek medical advice as soon as possible.
“The disease affects women as young as 20, although the risk increases with age,” she said. She repeatedly stressed that one crucial message that early detection can save lives.
Dr. Mah Munir said possible warning signs include a breast lump, a lump or node in the armpit, bloody nipple discharge, nipple retraction and changes in the skin of the breast and women if see these symptoms should immediately consult doctors.
“Some people have no symptoms at all at an early stage before detection,” she said, underscoring an importance of appropriate medical assessment and awareness.
For this reason, women should pay attention to unusual changes and consult qualified healthcare professionals rather than waiting until symptoms become severe.
The oncologist also advised women to maintain a balanced diet, maintain a healthy weight, exercise regularly, get adequate sleep and reduce exposure to potentially harmful chemicals and other known cancer risks.
At the same time, she emphasized that no lifestyle can guarantee complete protection from lethal breast cancer.
The most important step, she said, is not to ignore warning signs and to seek medical advice when something appears unusual in breast or around it.
“Shyness in women can cost precious time,” Dr. Mah Munir reiterated, adding in such situation cancer treatment can be critical.
She said one of the biggest challenges in fighting breast cancer is therefore not simply the availability of medicines or hospitals. It is also the delay between noticing a warning sign and seeking treatment.
Dr. Mah Munir attributed the large number of advanced cases seen in hospitals to shyness, ignorance, late diagnoses and social taboos.
“Women often come for treatment at the third or fourth stage because of social taboos, poverty and ignorance,” she said.
When cancer is detected at an advanced stage, treatment can become more difficult, expensive and emotionally demanding, while chances of successful treatment may decline.
The story of Farmeen Bibi illustrates that painful reality. The warning sign was there and a small lump had appeared but fear and hesitation kept it hidden.
By the time it was discussed openly within the poor family, the disease had already progressed.
She said breast cancer is not only a medical battle, it is also an emotional and social one.
Dr. Mah Munir highlighted the importance of family and community support for women undergoing cancer treatment, saying strong social networks can help patients cope with the psychological and emotional burden of the disease.
A woman facing cancer needs more than medicines and medical procedures. She needs reassurance that she has not become a burden.
She needs family members who will accompany her to appointments, listen to her fears and encourage her to continue treatment.
Most importantly, she needs to know that a cancer diagnosis does not diminish her dignity.
For families like Farmeen’ s, this message is particularly important. The response to breast cancer must therefore extend beyond hospitals and treatment centers.
Awareness must reach villages, schools, workplaces and communities where women may still feel uncomfortable discussing breast health or may have limited access to specialist doctors.
Health professionals and civil society organizations can play an important role in breaking the silence by promoting accurate information, encouraging timely consultation and challenging the stigma surrounding cancer.
Women should be encouraged to speak openly when they notice an unusual change in breasts rather than hiding it out of embarrassment or fear.
Families, too, have a responsibility to win fight against breast cancer. Instead of treating cancer as something shameful, they must treat it as a disease that requires compassion, medical attention and support.
For Noman, raising awareness especially through electronic and social media has become a way of keeping his mother’s memory alive.
He desired that more people may talk about breast cancer, particularly through social media and community awareness campaigns, so that other families do not experience the loss his family endured.
His mother’s story may have ended in grief and sorrow, but it does not have to end without a lesson.
Farmeen Bibi’s experience carries a simple message for every woman not to hide a breast lump, do not ignore an unusual change, and do not allow fear or social stigma to delay medical-care.
It also carries a message for families to stand beside women when they need you most.
Breast cancer can be frightening, but silence should never be the response, said Dr Khalid Mufti, former head of psychiatry department at Lady Reading Hospital Peshawar.
Rather to keep distance with victims, the society and families need to stand for support of such women.
He said early detection, timely diagnosis, appropriate treatment and emotional support can make a profound difference.
The federal government provides subsidized cancer treatment and medicines in erstwhile FATA, Azad Kashmir, Gilgit Baltistan and Islamabad through an agreement with Roche Pakistan at the Pakistan Institute of Medical Sciences (PIMS). The patients of breast, lung, and liver cancers are benefiting from the program.
The federal government covers 30% of the cost, while Roche Pakistan provides the remaining 70% of medication value under five years agreement.
The federal government has also revived the Sehat Sahulat Health Facilitation Program in Islamabad and surrounding areas to support eligible patient care.
For Farmeen’ s family, that difference is now measured in memories as a mother’s voice, a familiar presence at home and the painful knowledge that the warning sign was there long before the disease took her away.
Her painful story is a reminder that the fight against breast cancer cannot be left to patients and doctors alone. It is a fight for families, communities and society as a whole and the time is come to unite against breast cancer is now.
