ne in eight women in Pakistan, where only 48 per cent of children under six months are exclusively breastfed, is at risk of being diagnosed with breast cancer during their lifetime. Pakistan has the highest incidence of breast cancer among Asian countries.
According to the National Cancer Registry at the National Institute of Health, Islamabad, breast cancer is the most common cancer in both women and men in Pakistan, reaching epidemic proportions. This raises the question of whether there is a link between low breastfeeding rates and the high incidence of breast cancer in the country.
Health experts, including oncologists, say studies consistently show a decreased risk of breast cancer associated with breastfeeding, especially for 12 months or longer. This protective effect is due to hormonal, immunological and physiological changes during lactation. Breastfeeding has a greater impact on reducing breast cancer risk in premenopausal women and specific breast cancer subtypes.
“Breastfeeding lowers the risk of breast cancer in women. During the breastfeeding period, surges in estrogen hormone levels do not happen. This reduced exposure to estrogen could lower a woman’s risk of developing breast cancer,” says Dr Amina Khan, a consultant surgical oncologist at Shaukat Khanum Memorial Hospital Lahore. Citing research, she says a large study found that breastfeeding could decrease the risk of breast cancer by about four per cent for every 12 months of breastfeeding.
“Some people say, ‘My mother breastfed her children but still got breast cancer.’ We tell them it is not like an arithmetic formula that if you breastfeed, you won’t get cancer, but it is about lowering the risk. Breastfeeding lowers the risk of developing breast cancer and has a protective effect. We support it.”
Experts say that countries like China, India and Pakistan are witnessing a rising burden of breast cancer due to changing lifestyles, urbanisation and improved detection methods. In Pakistan, breast cancer is often diagnosed late, leading to higher mortality rates. Limited access to healthcare, low awareness and cultural taboos surrounding breast health contribute to this disparity.
A case-control study among Sri Lankan women aged 30-64, which included 100 cases of histologically confirmed breast cancer and 203 age and parity-matched controls, showed that women who breastfed for 24 months or more during their lifetime had a significantly lower risk of developing breast cancer than those who breastfed less than 24 months. Compared to women who breastfed for 0-11 months in their lifetime, there was a 66.3 percent reduction in breast cancer risk in women who breastfed for 12-23 months, 87.4 percent reduction for 24-35 months, and 94 percent reduction for 36-47 months. This study concluded that prolonged breastfeeding significantly reduces the risk of breast cancer and offers a protective effect.
Experts say while much is said about the benefits of breast milk for babies, breastfeeding benefits mothers as much as babies. It reduces the risk of diabetes and breast and ovarian cancer in women. Breastfeeding for any length of time compared to never breastfeeding is associated with a 10 per cent decrease in hormone receptor-negative breast cancers, which are more common in younger women. These cancers cannot be treated with hormonal therapy and often grow faster than the more commonly diagnosed hormone receptor-positive breast cancers.
UNICEF Pakistan’s chief nutrition expert, Anteneh Girma Minas, deplores that Pakistan has the lowest rate of optimal breastfeeding, including early initiation of breastfeeding (within one hour of birth), exclusive breastfeeding for the first six months and the introduction of age-appropriate complementary feeding while continuing breastfeeding at least until the age of two years, among South Asian countries. “Unfortunately, every other child does not get exclusively breastfeed during the first six months of age and more than 95 per cent of children aged 6-23 months in Pakistan are not getting the adequate diet required for their optimal growth and development,” he says.
Breastfeeding is beneficial for mothers as well as babies. It reduces the risk of diabetes and breast and ovarian cancer in women.
This is despite the fact that breastfeeding is the single most effective public health intervention for the survival, growth and development of children, as well as reducing the risk of certain health conditions for mothers, including ovarian and breast cancer.
According to him, breastfed infants have a reduced risk of asthma and severe lower respiratory disease, obesity and diabetes, among others. Breastfeeding also helps lower a mother’s risk for high blood pressure, Type 2 diabetes, ovarian cancer and breast cancer, he satgs. “As per the UK National Institute of Health report, the risk of breast cancer is reduced by 4.3 per cent for every 12 months of breastfeeding. The longer a mother breastfeeds, the more the risk is reduced. A study by Bano et al. (2016) also reported that a lack of breastfeeding together with other factors is found to have significant positive associations with breast cancer,” Anteneh says. He deplores that low awareness and cultural practices of pre-lacteal feeds, less birth spacing, low awareness about the correct technique of breastfeeding, maternal and child ailments, and unregulated advertisement and distribution of breast milk substitutes contribute to low rates of optimal infant and young child feeding practices.
“Breast milk substitutes are estimated to cost Pakistan over $888.6 million per year, a cost that could construct over 4,000 primary and secondary schools. At the current rates, not supporting breastfeeding is estimated to contribute to over 30,000 deaths per year in Pakistan, including over 1,500 deaths due to breast cancer, 600 deaths due to ovarian cancer, and close to 1,200 deaths due to Type II diabetes,” he claimed. The UNICEF Pakistan nutrition chief maintains that promoting, protecting and supporting optimal breastfeeding should be central to national strategies and programmes aimed at the prevention of breast, ovarian and other cancers among females in Pakistan.
To provide breast milk to premature infants whose mothers are unable to breastfeed them, Pakistan’s first-of-its-kind Shariah-compliant Human Milk Bank has been established at the Sindh Institute of Child Health and Neonatology, Karachi. This facility will provide donor milk to infants who are unable to receive their mother’s milk for any reason. Human milk banks primarily serve premature or sick infants in neonatal intensive care units whose mothers may not breastfeed. Donor milk can provide these vulnerable infants with essential nutrients, antibodies, and protective factors that support their growth.
The SICHN executive director, Prof Jamal Raza, calls breast milk a ‘superfood’ or ‘fast food’ for babies, saying it not only provides the required nutrition to infants but also the necessary antibodies and other protective proteins which prevent them from different types of infections, allergies and diseases later in their lives. “Unfortunately, breastfeeding rates have been declining in Pakistan for several years. Now less than 50 per cent of women exclusively breastfeed their children. This is because manufacturers of breast milk substitutes are influencing the mothers and luring them to give them formula milk instead of their own milk. Breast milk substitutes are prepared from cow’s milk with other added ingredients. These are not close to breast milk in terms of nutrition, immunity and the overall well-being of a child,” Prof Raza says, adding that one of the basic ideas behind the establishment of the human milk bank was to provide breast milk to premature infants whose mothers were unable to feed them due to various reasons.
As far as the benefits of breastfeeding for women are concerned, Prof Raza, an endocrinologist, knows that breastfeeding not only prevents women from breast and ovarian cancers but also lowers the risks of diabetes, cardiovascular disease, maternal stress, osteoporosis and postpartum depression.
Dr Khalid Shafi, general secretary of the Pakistan Pediatric Association, says that the use of medicines, especially antibiotics, can drastically be reduced among infants and children by promoting breastfeeding because breast milk provides the required nutrition and prevents children from contracting diarrhoea, pneumonia and other infectious diseases. He says that at the moment, the entire world is worried about antimicrobial resistance due to the irrational use of antibiotics. Promoting breastfeeding and vaccinating children against vaccine-preventable diseases are two best practices that can save children from disease and death.
“Promoting breastfeeding reduces the chances of diarrhoea and pneumonia by 50 per cent. It also prevents the use of antibiotics and other medicines among infants and children. At the same time, breastfeeding has many known and proven benefits for women, keeping them fit and healthy both physically and mentally,” he added.
The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International