Pakistan’s Pioneer Oncologist Changes Medical Culture

Dr. Zeba Aziz

Zeba Aziz, the first medical oncologist to practice in her native country of Pakistan, had personal reasons for entering the field of cancer medicine. When she was a student at the Fatima Jinnah Medical College in Lahore, her father developed chronic myeloid leukemia. At that time, bone marrow transplantation was available only in more developed countries. Her father traveled to England for treatment, and was away from his family for 18 months and died there.

We lost out on precious time,” she says. “He was only 42. That’s when you make relationships with your children. It’s important that families not be torn apart by cancer.”

Dr. Aziz’s father encouraged her to pursue medical research rather than clinical practice alone. And he wanted her to work in Pakistan rather than move permanently out of the country. After completing postgraduate training in the United States - at SUNY Downstate Medical Center and St. Vincent’s Hospital in New York - she returned to Pakistan in 1987 with board certification in internal medicine and the subspecialties of hematology and medical oncology. Today she is Professor and Head of the Department of Medical Oncology at Allama Iqbal Medical College at Jinnah Hospital in Lahore.

“When I returned to Pakistan, there was no concept of medical oncology,” she says, “and it was difficult to develop. I encountered a lot of resistance. It has taken 12 years to establish Medical Oncology as a subspecialty.”

What keeps her going, she says, are her patients, her students and the support of her husband and children. She also feels tremendous satisfaction in knowing she has brought important medical advances to her homeland.

Still, there are tremendous challenges. Illiteracy and poverty top the list, along with the government’s lack of attention to health care issues.

“How can people travel for cancer treatment, if they don’t have money to eat?” she asks. “If we provide them with medical care that is not constrained by financial issues, they do as well as anyone else.”

Oncologists in Pakistan also battle common misperceptions about cancer - that homeopathic medicines are preferable to standard medical care, and that cancer is not curable. The use of complementary medicine is common due to its easy access and low cost. The patients she sees at Jinnah are too often in late stages of the disease. Because the cost of mammography is prohibitive, she has launched initiatives to encourage clinical breast examination and breast self-examination in the hope of diagnosing the disease before it becomes advanced.

As a member of INCTR’s Breast Strategy Group, Dr. Aziz is conducting clinical trials that survey breast cancer risk factors, and is working on the development of a treatment protocol for locally advanced cancer. With INCTR’s help, she is also endeavoring to develop a professional educational program in partnership with Egypt and Tunisia.

Despite the rising incidence of breast cancer in developing countries, she says, 70% of patients have no identifiable risk factors. And no public health policies are in place to enhance awareness that would lead to early detection and treatment. Even at the professional level, cancer education needs to be improved. Medical oncology is not yet part of the curriculum of Pakistan’s medical schools. “A lot of patients don’t come because doctors don’t refer them,” she says. “More education is needed, and the government needs to step in, in order for us to achieve more.”

As a teacher, Dr. Aziz is succeeding in training physicians. But the research culture she dreams of has not yet materialized. “The research environment is so poor – there is no reward or recognition. That’s where I feel I’ve failed. They haven’t gone abroad and seen what I’ve seen - that evidence-based medicine is key to ensuring good quality medical practice. The ability to question things and to develop your own data is critical. That is where INCTR can help and is helping.”

Marcia Landskroener for INCTR