October is Breast Cancer Awareness month, and with breast cancer accounting for 14 percent of all cancers in women and rising in incidence even among younger women in their early 30s, it’s important for all of us to know the facts and be informed.
According to a recent report by Indian Council of Medical Research and National Centre for Disease Informatics & Research, breast cancer will be the most common cancer in women, affecting an estimated two lakh in India every year. This is an increase of 30 percent over the past one decade. The National Institute of Cancer Prevention and Research further highlights that of every two women diagnosed with the disease, one succumbs to it.
We spoke to Dr Kanchan Kaur, director of Breast Services at Cancer Institute, Medanta – The Medicity, about the reasons behind the growing rates of breast cancer, and how to prevent it. Dr Kanchan has trained at breast specialist centres in London, New York and Paris. She has been involved in setting up the Breast Services Institute at Medanta and has been a tutor for surgical courses conducted by the Royal College of Surgeons of London.
What are the possible reasons for the growth in incidence of breast cancer compared with other cancers in Indian women? Does lifestyle have a role to play?
There is no definite causative reason that can be pinpointed, but we do know that it is a lifestyle disease and multiple factors – like sedentary lifestyles, age at first childbirth, number of pregnancies, dietary changes and so on – contribute to it. Some women have a family history and have a genetic predisposition for developing breast cancer.
Breast cancer originates in the breast tissue when cells start growing abnormally and stop functioning like normal cells. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast or spread to other parts of the body, when left untreated. The more the delay in detection, the lesser the chances of cure
What is the prognosis after being detected? How many women can hope to go back to a normal life post-breast cancer?
Treatment for breast cancer depends on the stage of cancer. When breast cancer is detected at early stages and patients take all the recommended treatments, then the cure rates are in excess of 90 percent. It is one of those cancers in the body that have an excellent prognosis.
Treatments are not that difficult, and a lot of women continue to work though the treatment. Post completion of treatments, normal lifestyle can be resumed for a majority.
In the West where most breast cancers are detected in stage 0 and stage 1, up to 98 percent cure rates are seen. This is in stark contrast to India where up to 50 percent or more women will lose their life to breast cancer within five years of diagnosis.
The most common types of treatment are surgery, chemotherapy, radiation therapy, hormone therapy, and immunotherapy. Most women with breast cancer undergo surgery supported by chemotherapy as part of the treatment. Different types of breast-cancer surgeries are performed for different reasons such as removal of a tumour, restoration of the breast’s shape post-surgery, relieving symptoms of advanced cancer and assessing if cancer has spread to the lymph nodes under the arm. The most common surgeries are mastectomy and lumpectomy.
Is there any socio-economic group that is more prone than others to breast cancer in India? Which age group is most susceptible?
Breast cancer is seen to affect the more affluent population and this has to do a lot with lifestyle patterns. However, it is on the rise in all socio economic groups and the worrying trend is that all age groups are now at risk as we are seeing more and more cancers in the younger population.
What is the greatest obstacle you face as a doctor in proper diagnosis and treatment? Are there any social or cultural factors that keep women from opening up to their families or doctors?
The greatest obstacles come broadly in four forms:
- Misinformation, obtained largely by accessing Google
- Lack of information; most women are unaware about symptoms of breast cancer
- Stigma of cancer
- Fear of treatments and the side effects
We, as a society, need to be made aware that there is nothing to fear. Delaying treatments or getting unproven alternative treatments are the reasons why women lose their lives to this disease.
Among poorer sections of society, women’s health is the most neglected subject and they rarely have access to modern healthcare. How does this factor play out in the rising number of breast cancer cases?
Incidence of breast cancer is lesser in the villages than it is in the cities. However, outcomes are generally worse due to lack of awareness and poor healthcare facilities. For the village and poor populations, creating a bevy of social support workers, akin to the Anganwdi workers could go a long way in changing the face of cancer care in India.
Enlisting the role of NGOs could be of great help as they have voluntary workers who are passionate about the work they do. Local dispensaries and PHCs need to be equipped with medication and the staff need to be trained in diagnosing and dealing with cancer.
How far have the public and private sectors been successful in helping women have access to proper treatment, especially in the area of breast cancer?
Cancer care in India has changed significantly with emergence of private healthcare. In fact the best world class diagnostic and treatment facilities are now available in India. The sad reality however is that these are clustered in large cities and are inaccessible to a large section of the population.
Also, costs are a big determinant as most Indian households don’t have health insurance and are unable to pay for costly treatments. Public sector is already overburdened, and this impacts the quality of healthcare.
Also read: Why More Women Have Cancer Than Men in India
A major public ‘in your face’ information campaign is the need of the hour. This needs to target two major issues: one is of late presentation, which in turn increases the burden of palliative care population. Secondly, an understanding of the disease so that cultural beliefs do not override sensible treatment decision making process.
A significant proportion of patients choose to opt for alternative treatments with doubtful curative value. This wastes precious time and makes their condition unsalvageable. Revamping of cancer care services on hospitals is important so that it becomes more holistic and guides the patient and the family in a systematic manner.
Please share a list of signs and symptoms women should watch out for, along with other preventive measures women can take to ward off breast cancer.
Signs and symptoms include:
- A lump in the breast or underarm that persists after your menstrual cycle – this is often the first apparent symptom of breast cancer. Lumps associated with breast cancer are usually painless. This is a very important education as a lot of women will not seek medical help even after they feel a lump, because of the myth that if a lump doesn’t hurt, you need not get it checked. Although lumps are usually painless, tenderness or pain can be a sign of breast cancer in about 5 percent percent cases.
- A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt
- Unusual discharge from the nipple that may be clear, bloody
- Redness or rashes around the nipple that don’t heal
- Swelling around the collarbone and armpit
In terms of prevention, it is best to maintain a healthy weight, adopt a balanced diet, undergo screening regularly and avoid consuming alcohol. If you do, limit your intake.