Women In Kashmir Have Beaten Breast Cancer, But They Continue To Suffer

As the sun rose over the snow-covered Himalayas, Bilkees Khan struggled to lift the shutter of her shop. Fumbling about the bags she carried, whilst the keys clenched between her teeth, Bilkees gleefully welcomed her first client of the day. Owner of Bilkees Beauty Parlour, a go-to place for the women in Anantanag town of South Kashmir, Bilkees, 45, has been running the parlor since she was 17.

Bilkees shouldered the responsibility of her family, when her father, the lone bread-earner of the family, lost his eyesight.  While Bilkees’ elder siblings got along with their married lives, Bilkees endeavored to sustain her parents and a younger sister. As the life’s bumpy ride of the family moved ahead, a pothole of uncertainty and ruts of despair awaited Bilkees.

Bilkees married off her younger sister but the joy was short-lived. During the post wedding celebration, Bilkees, discovered a lump in her left breast while getting ready for the function. Frightened, Bilkees revealed it to her elder sister who shrugged it off saying, “it’s nothing everyone has it”. Trying to ignore the lump, Bilkees anxiously witnessed the lump growing in the next two months. Bilkees finally decided to waylay all her negative thoughts by consulting a doctor. 

“The doctor advised for Fine Needle Aspiration Cytology (FNAC) test, which suggested the lump was a normal gland which required a surgery. But unfortunately post-removal biopsy indicated third stage of cancer,” said Bilkees.

Bilkees underwent another unsuccessful surgery at SKIMS Srinagar with the tumor affected lymph nodes left behind. The family finally decided to take her to Tata Memorial Hospital, Mumbai where another surgery was performed. The mastectomy was followed by chemo and radiation therapy. While Bilkees now has fully recovered from breast cancer, its jolt still reverberates in her life. 

The interminable repercussions of cancer has cost Bilkees her marital life. 

In 2008, Bilkees married a man who was well aware about her medical condition. Bilkees’ doctors had advised her against conceiving. The man nevertheless married her with the promise of not letting the marriage affect her medical condition. But four years later, Bilkees learned about her husband’s second marriage.

“I had cleared everything with my in-laws. I told them about my medical complications but they assured me of being unruffled about it. But their behavior changed dramatically few years later. Not being able to handle the pressure of his parents, my husband finally married another woman without even telling me,” Bilkees said.

“Cancer took away my life bit by bit. Though the treatment increased my lifespan but my life has become no better,” Bilkees added.

In an alarming turn of events, the number of cancer cases in Kashmir has increased by 20 percent in just a year, with breast cancer accounting for the majority of cases and affecting more unmarried women. According to the latest figures revealed by the Regional Cancer Center at the Sheri Kashmir Institute of Medical Science (SKIMS) Soura, a total of 4,737 cancer cases were reported in the year 2021, up from 3,840 cases of cancer in 2020, with lung and breast cancer accounting for most of the cases. 

Breast cancer is one of the four most frequent types of cancer seen in women. The survival rate for breast cancer remains at a high of 90% and 84%. However, the intensity of the treatment exposes the patients to various side-effects. Though the patients live longer after treatment, they are more likely to experience psychological distress, such as anxiety and well as a lower health-related quality of life (HRQoL). Chemotherapy, as suggested by some researches, regardless of the type of cancer; ‘puts ovaries to sleep’. Mastectomy, the most common surgical treatment for breast cancer has considerable impact on the patient’s perception of femininity.

Pre-menopausal women with breast cancer are also sometimes advised to have their ovaries and uterus removed as part of their overall treatment plan because oophorectomy (surgical removal of ovaries) lowers the risk of the breast cancer returning. However, undergoing oophorectomy at a younger age may lead to more health issues in the future, such as an increased risk of osteoporosis or having a heart attack.

Tabia Dar, 40, has been waiting for her turn at a private clinic since an hour. Shuffling through the prescriptions, the receptionist finally signalled her to get in. Tabia was diagnosed with breast cancer in 2019. She had felt a consistent pain in her breast and subsequent mammography revealed cancer in her right breast. For Tabia, a mother of two young children, the ensuing treatment which included unilateral mastectomy and chemotherapy, exasperated her health issues when she underwent oophorectomy and hysterectomy (surgical removal of uterus). Since the surgery, Tabia has been suffering from traumatic ache in her legs and fatigue. Her doctor revealed oophorectomy a reason for the same. 

“After my chemo session, my periods didn’t stop and my doctors advised me to get my uterus and ovaries removed. Being a mother of two, I didn’t see any harm in it. But now I’ve realised the importance of ovaries in women,” said Tabia Dar.

“I suffer from high cholesterol and blood pressure. I experience fatigue, aches, hot flushes and mood swings. I regret being too gullible and not taking a second opinion before going for the surgery,” Tabia added, with a remorseful sigh. 

Dr Musaib Mushtaq, Resident, radiation oncologist SKIMS, Srinagar, while emphasising on the repercussions of oophorectomy said that, “Certain type of breast cancer is sensitive to oestrogen — a sex hormone released by ovaries in the female body. Such cancers thrive on oestrogen. While premenopausal women in such cases undergo hormonal therapy, postmenopausal women or the one who have already borne children might be advised to undergo oophorectomy.”

“Since oophorectomy brings about a number of health-related complications, it should be avoided as much as possible,” Dr. Musaib added.

While generally, older women like Bilkees and Tabia persevere through cancer-inflicted difficulties, because of the societal expectations of higher threshold of pain from women, for younger women, this condition has demonstrated to be negative for their mental well being. 

Raziya, 24, a college student, was identified to be carrying a cancer when she noticed a red patch on her breast while bathing. Her mother, recognising the severity of the symptom at once consulted a gynecologist, who after examining Razia advised them to take her to an oncologist. Upon consultation and succeeding examination, Razia was diagnosed with grade 2 cancer. The ensuing months were filled with chemotherapies, biopsies and surgery.

Razia underwent unilateral mastectomy in 2018. The yearlong treatment coerced Razia to drop out of college, which proved to be detrimental for her mental health. 

“I felt a sense of shame with my scarred body. While I was going through my treatment I barely talked to anyone. I avoided meeting people other than my family. I was disturbed and couldn’t fathom out the reason of my suffering,” Raziya said.

While Razia was going through the treatment for the cancer she was simultaneously treated for depression. 

Various researches suggest that, after diagnosis, the prevalence of depression and anxiety in women with early breast cancer is around twice that of the overall female population.

Dr. Fiaz Fazili, senior consultant surgeon and an expert on healthcare policy, while emphasising over the importance of multidisciplinary approach to in cancer treatment said that, “cancer patients especially women breast cancer patients face difficulty through the journey of treatment and post-treatment. Our institutions need to address the struggles faced by the patients in a holistic way. While the patient undergoes medical treatment, she must be exposed to counselors and psychologists who meet her emotional and spiritual needs.”

“Breast cancer and its treatment changes the way a women looks at her body. While breast reconstruction is an option available for survivors in most part of the world, our healthcare should too be well equipped to help the survivors regain confidence in the way they look at their bodies,” Dr Fazili added. 

Humaira Nabi is a freelance journalist based in Kashmir. She is a journalism postgraduate from University of Kashmir. She has covered wide range of issues including art, education, politics, health and gender. You can find her on Facebook and Twitter.

Featured image source: TheWire