Sometime back a patient presented in emergency with complaint of bleeding from an ulcer in breast and severe backache. As is typical she was referred from community health center in nearby town coming to us at 2:00 A.M. She appeared not to be worried about the lump in her breast or the multiple swellings in her axilla and other areas in her body ( she had metastasis and satellite nodules as well) but about the bleed from her ulcer. The surprising thing was that she is from well to do family and quite educated. In fact she did consult a doctor three years back who had advised mammogram and FNAC which had been inconclusive. She was asked to undergo a biopsy which she found bothersome and turned to home remedies/ ayurveda/ unani for treatment till now.
The sad part is that even her relatives are under the impression that she is fine. Her appetite is good; hasn’t lost weight hence must be healthy. “Doctor just give her some glucose (i.v. fluids) and blood and she will be fine” is what they say.
This is not the first time i have seen case of terminal cancer, but to go this way without trying is sad.
In our hospital (and i suppose in India in general) a large proportion of patients of Breast cancer present very late in the disease process. Mostly this is due to lack of awareness and access to medical facilities. The patients comes to the doctor only when the lump or discharge is noticed by friend or family member and forced to seek medical care. there is astonishing amount of ignorance and shame associated with the disease. This is the case not just in cancer but even more so in gynecological malignancies. I find patients are much more prompt in seeking care for abdominal or respiratory complaints.
