One in every 28 women in India is likely to develop breast cancer, and for every two women diagnosed with the disease, one dies. However, the official numbers are just the tip of the iceberg as there are no proper cancer registries in place yet.
The disease is particularly alarming owing to its unique demography in our country. More and more young women are being afflicted by breast cancer with the average age of incidence being 10 years younger than the population in Western countries. An earlier onset also means a more aggressive disease, and many women are being diagnosed at a more advanced stage when they first come to get examined, explains Dr N. Geetha Nagasree, a consultant surgical oncologist.
Q1. Why is detection of breast cancer late?
Late detection is due to lack of awareness, social prejudice, poor motivation and the traditional low priority a woman sets for her own health in an Indian family. But most importantly, it is the lack of a structured and organised screening programme. Every woman should be ‘breast aware’ — that means she should be able to notice any subtle changes in her breast and consult a doctor appropriately. Heightened awareness is important not just for those at a high risk of cancer, but for all women. Awareness should not just be with regard to the detection of a lump, but also several other changes such as change in the size of the breast, any nipple discharge or rash, thickening of the skin over the breast or lumps in the armpits.
Q2. What are the risk factors of developing breast cancer?
The risk factors include family history, where five to ten per cent of breast cancers are familial in nature; increased exposure to hormones like early menarche; late menopause; late first child birth; use of hormone replacement therapy and obesity. Interestingly, 50 per cent of the women who have been diagnosed with breast cancer do not show any identifiable risk factors at all, which means that there can be other reasons as well which are yet to be researched.
Q3. Is pain in the breast an indication of cancer?
No, pain is not a feature of malignancy. Pain could arise due to various other reasons but it is not an indication of breast cancer. Similarly, not all breast lumps are malignant and an overwhelming number of them identified in hospitals are benign, but every lump has to be diagnosed to rule out malignancy.
Q4. What are the guidelines for screening malignancy?
Latest guidelines state that every woman between the age of 45 and 54 should get a yearly mammogram done. Beyond 55 years, it should be done every two years. Those who have a family history where aunts or second cousins have been identified with breast cancer, must consider an MRI but only after consulting a doctor. 70 per cent of breast cancers are in the advanced stage. Due to the huge demographic set up of India, clinical breast examination is expected to give at least some help in identifying those cases which are in the early stages.
Q5. What are the limitations observed in women in terms of screening?
In clinical practice, we have found that women are not forthcoming in terms of getting themselves examined and this is seen even in highly social and well-educated families. Due to this reason, many cases are missed. There is also an inherent fear, especially in middle-aged and elderly women who are not willing to come forward.
Q6. The limitations could also be because of the aggressive nature of breast cancer treatment and the side effects of medicines. Is that noted at the clinical level? Please explain.
Breast cancer is now one of the most researched and scientifically studied diseases. The whole concept of management has undergone a sea change due to which personalised treatment has become a priority.
Earlier, treatment protocols were based only on the stage of the disease but that is not the case now. If the disease is detected on time, and with a favourable biology, there is no need to fear the disease. The concept of removing the entire breast is not being advocated now and the guideline is to reduce physical and psychological morbidity.
Q7. The word cancer is still dreaded by most people. In such a situation, is the guidance given to a patient sufficient to make her feel confident that the treatment will not maim or disable her?
The counselling doctor has to explain to the patient that the cancer is going to be treated just like chronic hypertension or diabetes. For this reason, support groups have been created in hospitals where existing patients come forward to help newly diagnosed patients and give them the confidence to go through the treatment.
The disease is no doubt still dreaded but efforts are being made to boost the patient’s life through the journey of the treatment. A positive attitude helps the patient and as well as her doctor.
