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How Patriarchy Dominates Breast Cancer in

South Asia
Words by Rimsha Qasim

BROWN HISTORY
26-OCT-2023 ∙ PAID

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 This map is a digitally rendered topographic representations of South
Asia (printed in 2D). In order to create these maps, Digital Elevation Data
(DEM) is obtained from NASA's Shuttle Radar Topography Mission and is
processed and digitally rendered to create a highly detailed elevation profile
of South Asia and printed on a flat surface. Two versions of the map are
available, each with different hypsometric colour overlays that highlight the
difference in elevation, creating beautiful artworks. (Available as print)

How Patriarchy Dominates Breast Cancer

in South Asia

"So, when a woman becomes ill, the total structure of the family is aVected,
they can't do anything…" - statement from a focus group study among women with
breast cancer conducted in India.

October is recognized as Breast Cancer Awareness Month. The iconic pink ribbon
October is recognized as Breast Cancer Awareness Month. The iconic pink ribbon
associated with this cause was [rst introduced in 1992 as part of a Western-led
campaign. Today, the world unites to dedicate one month to raising awareness and
promoting the prevention of breast cancer. However, there is one stark diVerence
between breast cancer in the West and in South Asia - the mortality rate.

The increasing mortality rate in South Asian countries has raised suspicions. The
incidence rate in Asia is among women in their forties, whereas in the West, it is more
prevalent among women in their sixties. The survival and mortality rate of any cancer
depends upon the severity of the malignancy. Patriarchal systems are still shaping
women's lives, even in decisions that are a matter of life and death. Women in South
Asian countries uphold cultural values of modesty, which deter them from talking about
breast cancer. In South Asia, the word 'breast' is considered taboo. The sexualization of
breasts has life-threatening implications for women, as any preventive and awareness
strategy relies on talking, initiating discussions, and active participation. Hence, many
women in South Asia are diagnosed with advanced and late stages of the disease.

A specialist at Shaukat Khanum Hospital, a leading cancer hospital in Pakistan,

conveyed that women are o^en taunted if they choose to undergo an examination or
treatment. The doctor also recalled one incident where a woman was made fun of and
compared to a man by her husband a^er a mastectomy. Shame plays a primary role
among factors that prevent women from getting examined. This shame results in women
being forced to only go to the doctor when the disease has reached an ultimate stage
requiring interventional surgeries. South Asian women feel ashamed of talking about
breast cancer with the male members of their family. Moreover, women are advised not
to go to male doctors to get their breasts examined. Ophira Ginsburg, a senior adviser at
the National Cancer Institute Center for Global Health, said, "Cancer is less preventable
in women than in men." Ginsburg started researching the inequities and patriarchy
aVecting cancer outcomes in women when she worked in a breast cancer clinical trial in
Bangladesh. There, she saw the worst cases of her career; her team noted how women
came in with advanced stages of the disease and felt they had no choice in the matter.
She stresses that things need to change on a policy level for women as so many cancer
risk factors marketed towards women are backed by patriarchal notions of beauty.

When gender dynamics assert that men are the family's primary breadwinners, power is
imposed upon women's reproduction and sexuality. In a review by Asian authors (Parsa
et al.), it was noted that " In Asian traditional culture, women's bodily experiences are
et al.), it was noted that " In Asian traditional culture, women's bodily experiences are
taboo." Breast cancer has such patriarchal inbuence because breasts are considered
important to female identity; men relate them to a woman's ability to nurture. Breast
cancer distorts the image of women in men's minds. This, in turn, leads to self-image
distortion in the women's minds. Furthermore, chemotherapy has a side eVect of
alopecia. Women lose hair and consider this as a loss of their femininity. Altogether, this
makes an incredibly hard and complex experience for women.

In Pakistan, one in every nine women is at risk of being diagnosed with breast cancer.
The mortality rate is around 40,000 deaths every year. In a Pakistani qualitative study,
major themes like shame, the idea of femininity attached to breasts, the role of service
providers, house chores, and discussing the disease with family members were explored.
This study researched the stigmas and the need to conceal medical diagnosis. Of many
statements in the study, one was of a rural housewife who stated, "Only the family
members know about the cancer. The rest only know about the lump, not cancer.
Because of frequent trips to the hospital, people do know something is going on." Many
patients also revealed that they needed to cover themselves in huge shawls so others
could not notice their post-mastectomy changes. A caregiver said that women o^en
falsely reported gastric issues or even heart problems while being aware of their breast
issues. Women in this study also reported feeling incomplete and unfeminine a^er
losing a breast. It was shocking how many women in the study felt that losing their
femininity, being unable to perform house chores, hair loss, and husband's second
marriage was far more devastating and life-changing than the cancer itself.

Similarly, in an Indian study, it was highlighted that " Cancer is more than a health
problem for Indian women; it creates a great annoyance in the family.”” The women who
participated in the study reported personal problems such as fear of rejection, social
negligence, husband's behavior, future of the family, incomplete responsibilities,
physical and economic burden, inferiority complex and lack of con[dence. Many women
struggle with body image issues a^er mastectomies; the patriarchal society instills these
complexes that intend to see the patients as victims, not survivors. Standards set by men
de[ne an attractive woman, the same standards are internalized by women even in
circumstances that are not under their control. This makes [ghting these battles harder
and isolates them from men and women alike. Another Indian qualitative study focused
on interviewing women with breast cancer, where women did not believe that men could
take on the responsibility of house chores. Women said that communicating about their
take on the responsibility of house chores. Women said that communicating about their
disease was out of the question, and the interview itself was very helpful. The study
[ndings indicated that women feel concerns over sexual health, physical health, body
image, children, and cancer recurrence under the context that their primary role in
society is that of a mother, wife, and caregiver.

The reality is not that diVerent for South Asian women who have immigrated to
developed countries. In one BBC article, it came to light that several UK women from
South Asian countries hide breast cancer because of the stigma related to this disease.
The experts revealed the women hesitated to seek treatment, resulting in premature
mortality. One woman thought that God was punishing her. It was also noted that little
information was recorded on ethnicity and mortality rate. There is much need for ethnic
data and central registries as it can help create tailored and targeted solutions for those
communities. It must be acknowledged that unique cultural experiences may make
disease management diVerent. The stigmas attached to diseases in South Asian societies
are unrelated to the Western experience. Hence, there is no one-size-[ts-all concerning
disease management. A report by the Lancet Commission published in September 2023
stated that more than 1.5 million cancer deaths worldwide in women could be avoided
through proper prevention. The report stressed equitable access to cancer resource
centers and funding opportunities as "patriarchy dominates cancer care, research, and
policymaking."

Survivors of breast cancer believe it is a lonely journey. Women's issues, including their
health issues, are kept very far down the list in a patriarchal society. The damaging
inbuence is not fully realized, and diseases like breast cancer remain under the rug.
Single women hide this disease because they believe they will not get marriage
proposals. Most women do not possess the con[dence to check on their breasts and
perform visual inspections. It has detrimental repercussions when cancer propagates to
other organs and exhibits complications. Advanced stages require advanced therapies.
These agonizing therapies and society's isolation are not easy to bear for women.
Therefore, they require familial support just like men do.

South Asian men must be targeted in breast cancer campaigns. Why are the campaigns
solely for women when the decision-making power lies with the men of their families?
The attitude regarding notions of femininity and motherhood must change, as this has
life-altering consequences for women who struggle with self-identity and guilt. It must
be stressed that the management and prevention is not on the women alone. Access to
care for women, funding opportunities for researching women's cancers, patriarchal risk
factors and post-treatment behavior must be thoroughly investigated, and better
preventive solutions must be implemented. There are disparities in providing care to
ethnic minorities and the information provided; a holistic and intersectional approach to
cancer can overcome these diVerences. Healthy women create healthy communities, but
society will collapse if their health is determined by those who dominate power
structures. Women who have breast cancer need to have the support of their family,
including their male family members. For this, the taboo of breast cancer stemming from
attaching a body part to gender identity should be discussed and gender norms
rede[ned. Awareness regarding breast cancer has not been enough; the complex
multifactorial barriers, the lived experiences of South Asian women and the long interval
in diagnosis and treatment have to be taken into account. Women in South Asian
countries must possess the freedom to take care of their health at their own will.

Credits:
Rimsha Qasim is a dentist and researcher from Karachi, Pakistan. She also takes on the
role of a freelance writer, cra]ing compelling stories that delve into her diverse interests.
When she's not working, she enjoys traveling, reading philosophy, and exploring
spirituality.

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