Breast cancer cases are more in younger women in India than in the West. Studies show that breast cancer in women younger than 35 years is seen in 1-2 per cent of the population in the West whereas in India it is 5-11 per cent. Fifty per cent of the patients consult a doctor at stage 3 and 4 of breast cancer and despite aggressive treatment the outcome is not good. For this reason, medical professionals are insisting on early diagnosis either by self-examination or regular screening so that the disease can be picked up at an early stage and treated properly wherein survival and quality of life are much better than in later stages.
Dr T Subramanyeshwar Rao, medical director and chief surgical oncologist at Basavatarakam Indo American Cancer Hospital and Research Centre explains the present challenges faced in India:
Q. What is the reason for the increasing incidents of breast cancer in young Indian women — especially among the 30-40 years old?
One important reason for higher numbers of younger patients is our major population comprises of the younger people and in them we are finding that early menarche and obesity is on an alarming rise in urban India. Patients of Indian descent residing in the West have the highest incidence of triple-negative breast cancer. In a study of 2,100 cases, Indian patients had higher incidence of triple negative disease than African-Americans, followed by Hispanic, Non- Hispanic White and Chinese patients. The reason for the high incidence of triple negative disease among early onset breast cancer patients of Indian descent remains unknown, but this disparity has been observed in different studies. From a public health point of view, these studies suggest that early onset of breast cancer must be considered as a diagnostic possibility in Indian patients presenting with palpable masses in the mammary glands. Thus, better education and wellness for patients and their families for breast self-examination and clinical breast exam at routine health checkups should be warranted. Additionally, medical attention should be immediately encouraged or sought upon discovery of a breast mass.
Q. When these young patients consult a doctor is there a stress on saving the organ so that the patient does not suffer from psychological problems? Is it possible to save the organ in at least 50 per cent of the cases?
The stress on saving both breasts and life is much higher among patients in young age groups. Unfortunately, young age breast cancers are associated with family history and have a genetic predisposition indicated by BRCA 1and 2 gene mutations. They are generally rapidly progressive, multifocal and less often amenable for breast conservation. It has been found that in some hospitals the practice of saving the breasts is followed in 80 per cent of the cases while in some it is as low as 1 per cent. This variability needs to be addressed by training Surgeons in all aspects of breast surgery across the country.
Q. It is being said that in breast cancer self-diagnoses is the best? Are there cases where women have self-diagnosed and found a problem and come forward? How many of them are cancer cases or mere lumps in the breast that are non-malignant in nature?
In a population of our magnitude breast awareness is indeed the best form of screening. It is simple and involves no expenditure. Lots of patients with lumps detected on self examination come to the centre and most of them are non-cancerous.
Q. Are patients now coming early (in stage 1 or stage 2) with so much of awareness being created or is there still a need to do more?
There is an upward trend but not to a desirable extent in comparison to the West. Out of every 100 women with breast cancer in the United States, 89 women are likely to survive for at least 5 years. In India this figure is not even 60 per cent. The reason is that even today more than 50 per cent patients of breast cancer consult a doctor at stages 3 and 4, and outcome is not as good as earlier stages, however aggressive the treatment may be. If you need to achieve this we need to diagnose early .The medical professionals should convince themselves that breast cancer is not necessarily a disease of old age and have to be alert to investigate any woman with a relevant symptom.
