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Uncovering a buried concern

Jun 13, 2017
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​Samina* will say that she is a breast cancer conqueror. Two long and trying years after being diagnosed with the big ‘C’, she is cancer-free. But her relief has been replaced by reality – a mastectomy of the left breast makes her feel self-concious and, when she looks in the mirror, incomplete.

She is always questioning herself: What if someone notices? Will I be publically embarrassed? Will I be pitied by my relatives and friends? For the moment she has resisted the urge to hide behind a shawl, but the anxiety remains with her every single day. 

Samina is one of many women interviewed by Zohra Jetha, senior instructor at the School of Nursing and Midwifery, as part of her recently published master’s thesis into the experiences of breast cancer survivors in Pakistan using external breast prosthetics (EBP).

In the western world, discussions about reconstructive surgery, cosmetic procedures and prosthetics are commonplace, but Ms Jetha, who has spent over six years working as an oncology nurse, noticed that patients in Pakistan are rarely counselled on how to cope with the loss of such a vital part of the female anatomy. 

Even though women who have undergone mastectomies often feel as though they have been ‘amputated’, many do not seek prosthesis – which range from crudely made straw prosthetics, padded cotton prosthetics, hand-stitched options and silicon varieties – because of a lack of awareness or a conscious choice to forego this option. 

Ms Jetha found that a major factor in women’s hesitation is the taboo surrounding the open discussion of reproductive and sexual health. 

“We belong to a society where discussions about the female body are considered ‘inappropriate’. This stigma means that many women conceal the pain of losing a breast or avoid drawing attention to their concerns as they worry that it will raise doubts about their fertility and result in marital problems,” Ms Jetha adds.

Household concerns also discourage women from seeking EBP. Since cancer treatment can be very expensive, many women feel hesitant to ask for help perceived to be ‘cosmetic’ and hence unnecessary. These barriers lead to women deciding to live with feelings of anxiety and inadequacy instead of seeking a simple solution which would make them feel confident again.  

If women do decide to wear prosthesis, they struggle to find quality prosthetics in the right size, and at an affordable cost. Interviewees also spoke of the challenges of living with prosthesis as they felt they could no longer wear light fabrics – a particular challenge in a warm country such as Pakistan. Since EBP have to be regularly washed, women also have to cope with a regular feeling of loss while replacing the device.  

Ms Jetha said: “Issues surrounding body image and self-esteem are often overlooked by researchers even though they have a great impact on a cancer survivor’s quality of life. This is unfortunate since prosthesis plays an important role in the recovery process and can help women return to their day-to-day lives.” 

*Name has been changed to protect privacy.

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