Breast Cancer Awareness Month: “Early Detection, Key to Survival,” Dr Karki.

Sarah Sapsanamma Rai

Breast cancer is the most common of cancers in women. In 2022, the World Health Organization (WHO) reported, around 2.3 million new cases with nearly 670,000 deaths. While much rarer, men can also develop breast cancer, accounting for roughly 1% of all cases worldwide. If nothing changes, the WHO has projected that by the year 2050, new breast cancer cases could rise to 3.2 million each year.

Marking the Breast Cancer Awareness month of October, our News Editor Sarah Sapsanamma Rai had an NTV World Insight conversation with Dr. Banira Karki, the first female Breast Oncology Surgeon in Nepal. Here are the excerpts.

What exactly is breast cancer, and how is it different from other cancers?

Breast cancer usually starts in the milk ducts or lobules of the breast. When those cells begin multiplying uncontrollably, they form a lump that can invade nearby tissue. Over time, it may spread through lymphatic channels to the underarm or even neck nodes.

Unlike other cancers, breast cancer typically originates in these ductal or glandular tissues and has specific patterns of spread through lymph nodes.

What kinds of breast cancer cases have you seen?

They vary a lot. I’ve seen it in girls as young as 15, those tend to be aggressive and fast-growing, and in women as old as 85, where the tumors are smaller and slower to progress.

Most of my patients fall between their late 30s and late 40s. Age plays a big role in how the disease behaves and how we treat it.

How are global and local trends changing?

Globally, breast cancer is on the rise. By 2040, we expect around 2.5 million new cases every year. In developed countries, death rates have gone down thanks to awareness and early detection. But in developing nations like ours, the number of deaths remains high even though detection is improving. The gap lies in awareness and timely access to treatment.

How important is early detection?

Extremely important. About 98% of breast cancers can be cured if found in the first stage, and around 90% if found in the second. But once it’s advanced, the chances drop significantly.

That’s why regular screening and awareness are key. Early detection truly saves lives.

Many people fear screening. What would you tell them?

Not every breast lump is cancer. Only about 20–30% are malignant; the rest are benign. So, there’s no need to panic if you feel something unusual, but do get it checked.

And mammography is perfectly safe. The radiation is very low, and it’s still the gold-standard test for early detection. Avoiding it out of fear can actually be dangerous.

How accessible is breast cancer diagnosis and treatment in Nepal?

Much more than before. We now have trained breast surgeons, mammography and PET-CT facilities, and all major chemotherapy and radiotherapy options available here. Even in remote areas, basic ultrasounds can help with early detection.

Earlier, patients had to travel abroad, but today the necessary expertise and equipment are available in Nepal itself.

What treatments are available?

Surgery is usually the first step. In the past, full mastectomy, removing the entire breast, was common. But now we perform breast-conserving surgeries, removing only the tumor and surrounding tissue, then reconstructing the breast for better cosmetic results.

Chemotherapy, radiotherapy, and hormonal therapy are also part of the treatment plan, depending on the cancer’s stage and type.

How do you decide which treatment a patient gets?

We don’t decide individually, we hold a tumor board meeting with surgeons, oncologists, and radiologists. Together, we review all the test results and determine the best approach.

The decision depends on tumor size, stage, and type. For example, if the tumor is large or aggressive, we might start with chemotherapy to shrink it before surgery. For smaller or localized tumors, surgery comes first.

What is breast-conserving surgery?

It means removing the tumor along with a small margin of healthy tissue, while keeping the rest of the breast intact. After removing the tumor, we reconstruct the breast using oncoplastic techniques so the shape looks natural.

If the entire breast must be removed, we can rebuild it with implants or tissue from other parts of the body, like the abdomen or back.

Do cosmetic or enhancement procedures increase cancer risk?

No, not at all. Whether it’s a breast reduction, reconstruction, or silicone implant, these procedures do not cause breast cancer. They’re safe when done properly.

Is breastfeeding related to breast cancer risk?

Yes. Breastfeeding is protective, it reduces estrogen exposure in the body. The same goes for pregnancy. Women who have children and breastfeed are at lower risk. Those who haven’t had children or haven’t breastfed have a slightly higher chance of developing breast cancer.

What’s the ideal age for childbirth in terms of cancer prevention?

Having your first child before 31 is considered protective. Statistically, it lowers the risk.

Why do some people still go abroad for treatment?

It’s mostly out of habit and old perceptions. Years ago, we didn’t have good cancer centers or trained specialists here, so people went to India. But that’s changed.

Now, we have capable doctors, proper infrastructure, and advanced technology in Nepal. Plus, regular follow-ups are easier to manage when you’re treated in your own country.

Can breast cancer return after treatment?

It can, depending on the cancer’s stage and type. Aggressive types like triple-negative or HER2-positive cancers have a higher chance of recurrence, while hormone-positive cancers have a lower risk.

That’s why regular follow-up is essential, even after successful treatment.

What about breast cancer in men?

It’s rare, only about 1% of all breast cancer cases. Men usually present with a lump, skin change, or nipple discharge. It mostly appears after age 60, and the treatment approach is very similar to women’s.

What is life like for patients during and after treatment?

It’s tough, both physically and emotionally. Chemotherapy causes hair loss, fatigue, and emotional distress. Many patients feel isolated or anxious about their appearance.

But after treatment, most of them come out stronger and more confident. They’ve fought a major battle and often gain a new perspective on life.

Dr. Banira Karki is the first female Breast Oncology Surgeon in Nepal with a Special interest in breast conservative surgery and reconstructive surgery. Dr. Banira Karki has more than 10 years of experience in the field of surgery. Her main interest is oncoplastic and breast reconstruction surgery, achieving the best outcomes in cancer surgery and breast appearance.