Breast cancer is underdiagnosed in India: Causes, tests, treatment options you should know

Breast cancer is the number one cancer among Indian women and accounts for 14 percent of all cancers in women. Overall, 1 in 28 women in India (in urban areas, 1 in 22 women and in rural areas 1 in 60 women) is likely to develop breast cancer during her lifetime in urban areas. The number of breast cancer cases reported every year is increasing at an alarming rate. As per Globacan 2018 data, breast cancer accounts for more than 27 percent of all new cancer cases. As per ICMR data from 2018, over 1.5 lakh new breast cancer patients have been recorded in India. There is an increase in the trend of new cancer patients, and the age group of new patients coming annually have gradually dropped from <55 years to under 40 years of age.

The overall numbers in India are better compared to the numbers for developed countries like US/ UK is less where 1 in 8 women are diagnosed annually. However, as the awareness level about the disease in developed countries is quite high and there is a lot of government funding which promotes timely detection, most cases are detected and treated at early stages leading to better survival rates.

The yellow box indicates where cancer was spotted in the mammogram by AI, which radiologists failed to detect. Image: Northwestern University

In India on the other hand, the survival rates are quite low due to high population and low awareness ratio. One out of two women diagnosed with breast cancer die within the next five years which attributes to 50% mortality rates. One of the biggest reasons for the high mortality rates is a late diagnosis which is primarily due to lack of awareness and the absence of proper breast cancer screening programme, diagnosis at advanced stage and unavailability of appropriate medical facilities. Majority of breast cancers are diagnosed at a relatively advanced stage. Many patients in the urban areas are diagnosed at stage two when the lesions become palpable lumps, but in most cases from rural areas, these lesions are diagnosed only after they transform to metastatic tumours.

The causes of breast cancer

While the exact causes of breast cancer are still unknown, several risk factors have been identified through years of medical research. It is still unclear why some women who have no risk factors can also develop breast cancer while some women who are at very high risk never get affected. It is best to stay cautious and aware of warning signs, risk factors and preventive measures.  The risk factors for breast cancer include genetics and heredity, sedentary lifestyle, late or no pregnancy, use of oral contraception, early start to menstruation, late menopause, excessive intake of alcohol, smoking, increasing obesity among youngsters, stress and poor dietary intake – these factors have been attributed to increase in the incidences of breast cancer among the young Indian women.

Unfortunately, there are still no ways to completely eliminate the risk of breast cancer. Risk factors such as inherited changes in certain genes (BRCA1 and BRCA2), family history etc are beyond our control. If you have a family history of breast cancer – your mother or sister get a cancer tumour marker done regularly or as advised by your doctor. We can however minimise its impact by detecting it as early as possible. Early detection offers the best protection against breast cancer.

Recommended screening protocol

Numerous studies have shown that regular screening of women with no symptoms of breast cancer has lowered the number of women who die from the disease. The purpose of breast screening is to find breast cancer at its earliest, when the treatment is known to show best results.

Self-Breast Examination

>20 yrs             To be done monthly according to menstrual cycle

Clinical Breast Examination

20 – 30 yrs                    Annually

30 – 60 yrs                    Half-yearly

>60 yrs                         Annually

Screening Mammogram*

<40 yrs             Ultrasound for evaluation of any suspicious findings on clinical breast examination

40-55 yrs          Annual mammogram

55-70 yrs          Mammogram every two years

*To be done only after assessment of breast density by baseline mammogram

A female technician positions a women at an imaging machine to receive a mammogram.

When should you consult a doctor? 

Ideally, you should consult a doctor as soon as you see any change in your breast. This can range from a lump, an unusual pain that does not go away or any type of discharge.  The following signs are indicative of changes in your breast and possible symptoms of breast cancer which need immediate attention.

  • Change in the size, shape, or appearance of the breast
  • A lump in the breast or just below the armpit
  • Changes to the skin over the breast, such as dimpling
  • An Inverted nipple
  • Scaling, peeling, or crusting of the skin around the nipple
  • Redness of the skin over the breast
  • Blood or any unusual discharge from the nipple

Treatment options

There are four treatment options for breast cancer

  1. Surgery
  2. Chemotherapy
  3. Radiotherapy
  4. Hormonal therapy

The treatment protocol is formulated based on the stage of diagnosis. All patients might not need all four treatment options. The advantage, if breast cancer is detected early is that a breast conservation surgery can be done (rather than removing the entire breast) and more importantly, chemotherapy can be avoided in select group of early breast cancer patients.

So, keep checking for any abnormalities/unusual changes in your breast from time to time. Remember, early detection is key for the proper treatment of breast cancer. For better treatment outcomes and higher survival rate, early detection is critical.

The author is a breast oncologist and heads the Breast Centre at CK Birla Hospital.



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