October is observed annually as Breast Cancer Month and various programmes have been held in the sultanate to increase cancer awareness. One of the tireless crusaders in this field, Dr Rajyashree Narayankutty, proprietor of  Barakath al Noor Clinic (extreme right in the photo), shares her own perspective of cancer in Oman and how it can be significantly curbed in the long run

From your perspective, why is it so important to raise awareness about common cancers, particularly breast cancer, in Oman?

The number of new cancer cases increased by 165% between 1996 and 2019, from 787 to 2,089 cases. A more significant increase in females (48%) compared to males (7%). Breast Cancer incidence is increasing all over the world and in Oman, and is the most common cancer in the country and the commonest in women as well as commonest cancer related deaths in women in Oman.

The most common cancers in Oman are – breast, colorectal, thyroid (women), and prostate, colorectal and liver (men). Late stage diagnosis can be avoided, and early diagnosis can encouraged by raising awareness among the community, to reduce mortality and morbidity. This is more in case of breast cancer which is a growing burden in Oman, mostly due to the social and cultural stigma, and lack of awareness.

Why do you think breast cancer in particular has become the focus of such awareness campaigns worldwide?

There has been significant increase in the incidence of breast cancer all over the world, in terms of  mortality and morbidity. The main reasons being – it is a silent invader, no single cause has been found, the social stigma attached, the myths involving this disease, and above all, the lack of awareness about breast cancer.

There has been encouraging results in women going for regular checks and detecting early which, in turn, is the key to better survival as well as reduction in mortality and morbidity rates. The community should be educated about the fact that breast cancer develops from a combination of genetic, environmental, and lifestyle factors. And that many of these (about 80%) can be controlled and managed.

Are women in the Gulf region generally aware of the importance of regular screening and early detection? What gaps do you see?

Women in the gulf region are gradually getting more aware of breast cancer screening, importance of early detection, due to the various campaigns, seminars, events by CSR dept of companies, organisations (Oman Cancer Association – the only NGO in Oman) breast cancer societies, hospitals, institutions etc, besides social media initiatives, which is the best influencer in the present era.

How much does cultural perception or stigma still play a role in delaying diagnosis or treatment?

Cultural factors play a significant role in the late-stage diagnosis of breast cancer in Oman and in the Gulf as well as Asian countries. Late-stage diagnosis is defined as the detection of breast cancer after the cancer cells have spread to other parts of the body. Many Omani women are reluctant to seek medical help due to modesty, fear of stigma, and lack of awareness. Additionally, there is a misconception that breast cancer is incurable, which discourages women from participating in screening programmes. Traditional beliefs and reliance on alternative medicine also delay diagnosis and treatment.

What role do family members and community support play in encouraging women to come forward for screening?

It is important to raise awareness about breast cancer, living a healthy life style, and emphasising the importance of regular breast screening, and early detection. Most women are in fear of diagnosis, and some are restricted by cultural and social limitations, and yet a few due to lack of accessibility to information and education about the disease. So, when the working men or women of the family are aware about such screening programmes, they should support and encourage the women in their family to go and attend the same. They should also talk about the risk factors, preventive and protective measures, and explain about the importance of early detection, and not to fear cancer.

What initiatives are currently in place in Oman to improve cancer screening and early detection?

Key breast cancer screening programmes in Oman include the Oman Cancer Association’s (OCA) Mobile Mammography Unit, which provides free screening to women over 40 all over the sultanate and, the one-stop breast clinic at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCRC) for prompt diagnosis.

The OCA also offers free Clinical Breast Examination (CBE) and Self-Breast Examination (SBE) training to women of all ages at its free clinic, and conducts awareness campaigns in various settings. Many private hospitals and clinics also promote screening programmes throughout the year – more during February (World Cancer Day – Feb 4) and during October.

How do lifestyle factors—such as diet, obesity, smoking, or lack of exercise— impact cancer rates?

The lifestyle factors that can be controlled by us, have a great impact in the incidence or development of breast cancer, as well as the outcome of treatment of breast cancer. All over the world, modern lifestyle and dietary habits, including a diet high in processed foods, processed red meat, sugar, salt, and saturated fats, along with physical inactivity, obesity, high stress, lack of sleep, alcohol, and tobacco use, are significant contributors to cancer.

The need of the hour is to educate from early age the importance of a healthy lifestyle, and to avoid processed foods, encourage physical activity and hobbies to reduce stress and emphasise the importance of knowing what is normal for one’s body, and to seek help if there is any abnormal change.

What are the main challenges faced by cancer specialists?

Misconceptions, social stigma, myths and false beliefs about cancer – causes, tests, treatment, are main challenges, as well as lack of awareness among the public about the disease, especially about regular check and early detection, and the great possibility of completer cure, if detected early, and the treatment options and facilities available in Oman.

Thanks to His Majesty, the Sultan, and the government, for the free but best medical facilities for cancer treatment in Oman. However, it is important to do regular screening to detect early, which would reduce the expenses for the government.

Has treatment and survival rates for breast cancer improved in recent years in Oman?

Definitely, there has been a great improvement in the treatment and survival rates of breast cancer patients in Oman, thanks to the National Oncology Center and the new SQRCCC with the state of the art equipment and advanced treatment facilities, and highly qualified staff. Compared to before, less Omani patients seek treatment for breast cancer outside Oman.

At the one-stop breast clinic, there is accessibility of an early appointment system and immediate care where patients can undergo a series of tests, including a physical examination, mammogram, and ultrasound, in a single appointment, as well as if diagnosed, initiation of treatment using a multi-disciplinary strategy.

Support services also include psycho-social and rehabilitation care for both patients and their families, a complementary medicine suite, and a home care unit. The Burjeel Hospital and Aster Royal Al Raffah Hospital are two hospitals in the private sector that give oncology services to cancer patients while Oman Cancer Association supports patients through psychological services and awareness sessions. Barakath Al Noor Clinic since 2008 has been actively involved in spreading breast cancer awareness, promoting regular breast check and facilitating early diagnosis and reducing the gap for initiating the treatment by prompt referral to SQRCCC/ NOC/ home country for further expert management, and psychological support during the journey of treatment.

Lastly, since breast cancer incidence is increasing in Oman, we need 365 days reminders about the three Ps – prevention, protection and periodic examination . Every individual should Be Aware, Be Alert about one’s own health.