Despite concerted efforts to raise awareness every year, breast cancer remains a key cause of concern in Oman as many women prefer to keep it under wraps until it is too late. ‘It might be time for men to take the initiative ensure that female members of every family undergo regular screening,’ says Dr Rajyashree Narayanankutty, who specialises in breast cancer diagnosis in Oman, in an exclusive chat with Muscat Daily

In June 2023, the Directorate General of Health Services of Muscat Governorate, represented by the Department of Primary Health Care at the Ministry of Health (MOH), in cooperation with Oman Breast Cancer Society and Sultan Qaboos Comprehensive Cancer Care and Research Centre had organised a health symposium on early detection of breast cancer, to raise awareness and urge women to perform the early detection of breast cancer.

The symposium defined breast cancer as well as touched upon detection and prevention methods, treatment, the psychological and family dimension caused by the disease to the patient, the role of healthy food in avoiding the disease, as well as the importance of breastfeeding for the child. However, the stigma associated with breast cancer yet compels many women to neglect themselves causing irreparable damage.

Dr Rajyashree Narayanankutty, an award-winning Breast and Perianal Diseases Specialist and General Surgeon, specialising in Breast Cancer diagnosis in Oman for over 25 years at Barakath Al Noor clinic, al Khuwayr, has called on all women to undergo regular screening so that they can detect irregularities early and avail of timely treatment.

Is the situation regarding breast cancer incidence in Oman a matter of concern?

Certainly, it is alarming and not acceptable, in spite of the awareness programmes conducted by various organisations and health institutions. We have to act from immediate effect – it is ‘the need of the hour’. Various awareness programmes have encouraged more ladies to go for breast checks, and many have been identified. However, Breast Cancer Awareness should be continued throughout the year, and not restricted to the month of October or World Cancer Day (February 4).

What do you think are the key causes of rising cases in Oman?

The rise in the incidence of breast cancer is all over the world, mainly due to lifestyle changes, and lack of persistent awareness, even though there have been a lot of awareness programmes. Health has not been a priority for most people.

Is it time for concerted efforts by public-private sector institutions to tackle this problem together?

I believe, that breast cancer awareness should be done 365 days of the year, with constant reminders by various institutions, health centres and by health care workers.

Why are women in Oman hesitant to undergo periodic screening?

Health is not in the list of priorities for most women, and self-care is also not prevalent. Balancing multitasking and self-care has been an issue among most women. Most are shy or in denial or scared of detecting something abnormal.

Have awareness/screening camps not reached all areas in Oman?

Besides existing efforts, we could do much more awareness campaigns through schools, colleges, local women’s associations and in institutions that employ more women staff. There is definitely more awareness now, than 15 years ago, and more women are being diagnosed at an early stage. However, getting women to go for regular screening has been a challenge.

At what stage do most women come forward? Why?

Women still wait for symptoms to appear, and do not go for regular screening. So by the time the symptoms do appear, if there is cancer, it is usually identified as 3rd or 4th stage. Unlike the west, we do not have National screening programmes yet for breast cancer, but we have to definitely thank Oman Cancer Association, founded by HE Yuther al Rawahy.

There is round the year screening of women above 40 by the Mobile Mammogram Van that goes all over Oman, which has screened more than 25,000 women, so far. Recently with great efforts, OCA has been successful in getting two more MMUs – in Sohar and Dhofar regions, so that more women can be screened.

Also, the Oman Breast Cancer Society, headed by Dr Adil Mohammed Aljarrah Alajmi, are doing regular breast cancer awareness programmes.

Is breast cancer still a social stigma in Oman?

Yes , breast cancer is still a social stigma, and people would not want to talk about it. Mainly, since it involves the personal and sensitive part of womanhood, women do not want even their own partner to know about any problem in their breasts, fearing isolation.

What are the key concerns of women in this regard?

Every women affected by the disease is worried about the loss of hair due to chemotherapy and loss of femininity – which may affect her relationship with her spouse, the family and friends. Above all, they are very worried about not being there for their children, and in their future.

Is there need to shift the focus to educating male members of the family?

I strongly believe that men of the society or male members in a family  should be educated and given awareness about the importance of women in the family undergoing regular screening, besides being counselled on acceptance and support for an affected female member diagnosed with breast cancer.

Have you initiated any unique efforts in this regard?

We have developed a special, simple easy to use, one of its kind app – Fatma’s ‘Promise Al Noor’ – for smart phones, with illustrations about self breast examination (SBE) in Arabic and English, launched In December 2016. Designed by my children (Dr Sri Mookambika and Sai Aditya), developed by Stackon Technology, Trivandrum, and supported by Honarable Lujaina Mohsin Haider Darwish, in memory of her mother.

Any suggestions for enhancing the efforts?

It would certainly be helpful to have more awareness as well as screening programmes throughout the year at the secondary health centre level. If we have to curb the incidence rate of breast cancer in Oman, we have to undertake initiatives on a war-footing. Non-governmental organisations need to be provided more trained staff from government hospitals for assisting in reading/maintaining patient records as well as management of patients with suspicious lesions.

What is your clear-cut message to young couples?

The newly married couples should give importance to living a healthy lifestyle with emphasis on good healthy food habits, regular exercise, open communication, reduction of stress, and have adequate sleep, and give priority to health and self-care. Early detection saves lives, be aware of risk factors and seek immediate help.

Cancer incidence in Oman

According to a report – Cancer Incidence in Oman 2019, released by the Ministry of Health, Department of Non-Communicable Diseases, Directorate General of Primary Health Care, the total number of all tumours registered in 2019 was 2,307.

Of these, 2,089 (90.55%) were among Omanis, 200 (8.67%) were Non-Omanis and only 18 (0.78%) cases were carcinoma in Situ.

Of the total 2,089, males accounted for 931 cases (44.57%) and females accounted for 1158 (55.43%) cases. Overall, breast cancer, predominantly female, was the most common cancer, with the median age at diagnosis being 48.5 years, followed by thyroid cancer and colorectal cancer.