Dr. Azmina Valimohammed, Clinical Oncologist, Aga Khan University Hospital is a well known personality in the field of Oncology. She was recently interviewed by Muhammad Fareed, Publisher & Managing Editor, Medical Review along with his team. Following are the excerpts.
Q1 – Please tell us something about yourself.
Ans – I am a graduate of the Aga Khan University, belonging to the 3rd batch. After obtaining MBBS, I left for USA where I had my post graduate training in Internal Medicine, followed by Hematology and Oncology fellowship and attained Board certification in Internal medicine, Hematology and Oncology.
After returning to Pakistan, I had the opportunity to work at several institutions and private hospitals and finally settled at the Aga Khan University Hospital.
Q2 – What are the different cancers you encounter and which are more prevalent.
Ans – I have dealt with all kinds of cancers, but my interests are Breast and Gynecologic malignancies.
In women these are the commonest cancers that we see. It is not possible to give the prevalence as there is no Tumor registration system in effect which would provide us with the accurate numbers without duplication of patients as patients have a tendency to seek multiple opinions.
Q3 – What is the incidence of breast cancer. Is there institutional record to know more about incidence.
Ans – Worldwide the risk of developing cancer of the Breast is one out of eight women. There are medical records available, atleast at the Aga Khan University Hospital from which information can be gathered but this may not reflect the true incidence as patients reported at the Aga Khan may not be representative of the entire population of Karachi or Pakistan
Q4 – What is the level of treatment of cancer and breast cancer. What further facilities are needed to improve treatment.
Ans – One has to keep in mind that cancer treatment is a multidisciplinary approach in which medical oncologist not only treats the malignancy but also facilitates treatment by radiation oncologist and surgeon. A well trained pathologist with a sound laboratory and radiology facility are integral in carrying out treatment of a cancer patient.
At private level Aga Khan University, SKMCC, Ziauddin Hospital and LNH are conducting integrated services. Similarly Government institutions commissioned by the Atomic Energy Commission such as KIRAN, NIMRA and so on.
Q5 – There is need of awareness campaigns. In which areas and ways it can be arranged.
Ans – Cancer risk factors do not allow smoking. Awareness begins with the knowledge of risk factors that predispose an individual to a particular kind of cancer, its prevention, early detection and availability of various modalities of treatment.
So for instance, cigarette smoking is a risk factor for lung cancer, head and neck cancer, pancreas and kidney cancer, so the best way to prevent is to not start or quit smoking as well as second hand smoking. Smoking should be banned in public places, restaurants etc. Children be educated at an early stage with no smoking campaigns. Knowledge of signs and symptoms of cancer should be told through media education so that treatment delays are prevented.
Q6 – What is the role of pharma companies in creating awareness.
Ans – Pharmaceutical companies have a large budget which can be used in sponsoring programs at school, colleges and community level.
Q7 – Have awareness been introduced among women for breast cancer. The task and target is large.
Ans – Yes, it is but the task and target is massive. For start October is the month dedicated to breast cancer awareness throughout the world. Globally, presentations on its risk factors, signs and symptom, seminars are held to educate the common man.
Celebrities also come forward with their personal stories and of friends and families afflicted by this disease. Moreover counseling is also carried out to support patients and families undergoing treatment. It is also a month in which breast cancer survivors get an opportunity to share their personal stories and this serves as a source of encouragement to the patients.
Similarly, advertisements, radio and Television serves as a good medium to disseminate information.
Q8 – How is hormonal therapy effective in breast cancer.
Ans – When we talk of Hormonal Therapy, the common belief is that it consists of giving Hormones to treat breast cancer. This is not correct. Certain breast cancers are under the influence of the female hormones that are produced in the ovaries, reproductive organs,. When these hormones act on the cancer cells it leads to their multiplication and spread. Now if one removes the source of production of these hormones or blocks the growth of the cancer cells where they act towards cell growth, then this leads to cell function cessation and cell growth.
This type of treatment is applicable only for those patients who have “Hormone Responsive “ disease and hence generalizations of treatment should not be made.
Q9 – When is preference given to hormonal therapy for breast cancer treatment.
Ans – I think the above description should answer the question.
Q10 – What is the incidence of breast cancer in rural and urban areas.
Ans – Unfortunately, we have no demographic and epidemiologic data available for this.
Q11 – Are the students in medical colleges getting sufficient teaching in the subject of Oncology. If not then what do you suggest in improving the teaching standard.
Ans – The model followed at the Aga Khan Hospital allows a brief exposure to patients in the wards and clinic. The objective is not for them to learn about the various drugs and protocols, but it is for them to know the basic principles of treatment , to show compassion and concern for these patients when they go out and practice in the real world.
Medical student exposure equips them with the capability of carrying out sound history and examination which then directs them to a particular illness or illnesses which can then further be investigated and confirmed with laboratory and radiologic testing.
Q12 – The GPs have the role of referring cases to cancer hospitals when patients come to them. It is general impression that they do not in effect follow this practice. Do you agree and what can we do about it.
Ans – As a specialist I see 20 – 30 patients a day, the reason being the nature of illness demanding a thorough knowledge of the disease, patient education about their cancer, answer queries about treatment benefits, side effects and prognosis along with providing them psychosocial support. As compared to us the generalists see 2 -3 times the number, they are the gate keepers for these patients. An immense responsibility falls on their shoulders to guide the patients in the right direction. Our people usually tend to have their family physician who they trust and seek guidance from. I would urge them to pay attention to the signs and symptoms of their patients, any chronic symptom needs to be investigated and referred in a timely manner. (Courtesy – ICI Pakistan Ltd.)