Breast cancer is the most common cancer seen in Indian women and accounts for 14% of all cancers diagnosed in women. It is reported that every four minutes, a woman is diagnosed with breast cancer in India. It is alarming that a higher percentage of Indian women are developing this disease at a younger age, in comparison to their counterparts in the West. This makes early detection and intervention crucial in improving outcomes and saving lives.
Lack of awareness about breast cancer often leads to late diagnosis, contributing to high mortality rates. In our vast and diverse country, misconceptions about breast cancer are prevalent and the social stigma associated with cancer, contributes to the late presentation. By educating and creating awareness among women, we can empower them with knowledge about risk factors, symptoms, and the importance of early detection. It is vital to debunk myths, dispel fears, and encourage open conversations among women about breast health. This will enable them to take proactive measures towards their own health and will lead to early detection.
Two most important risk factors for breast cancer are being born as female and old age. Rarely, breast cancer can also be seen in men. Other common risk factors include family history of breast and ovarian cancer, being overweight, lack of physical activity, overindulgence in junk food, sedentary lifestyle and alcohol consumption.
Monthly self-examination
Women should be educated about the warning signs of breast cancer, which include any lump in the breast, changes in size or shape of the breast, dimpling of skin, nipple discharge, particularly blood-stained discharge, or recent nipple retraction. It is important to note that the lump of breast cancer is painless to begin with, pain develops at an advanced stage. Therefore, any painless lump in the breast should immediately be investigated.
Breast self-examination is a simple and cost-effective way to detect breast cancer at an early stage. It can be done in the privacy and convenience of one’s home. It involves systematically palpating the breast, every month, with one’s hands to feel for a lump. Women should be taught about the correct method to perform breast self-examination so that they become aware of the normal look and feel of their breasts and can quickly identify any changes or abnormalities. It is important to note that a normal breast may feel nodular or a little lumpish; so, a monthly breast examination helps to detect change.
Clinical examination, awareness
The second method of screening, recommended by the Government of India under the Prevention and Control of Non-communicable Diseases (NCDs) guidelines, is called clinical breast examination (CBE) in which a doctor or a trained health worker palpates the breast and tries to feel for a lump to detect early signs of breast cancer. Another screening method most commonly used is mammography. It is important to state here that mammography is most effective when done on women in the 45-50 years age group.
Recent evidence has shown that CBE may be as effective as mammography in detecting early-stage cancers. There are also concerns about false positive cases and over diagnosis rates with mammography. In a resource-constrained setting like ours, mammography may not be an ideal method for mass screening.
Even though breast cancer can be detected at an early stage, regrettably, the uptake of screening and awareness among Indian women is dismal. We must remember that cancer detected at an early stage is comparatively easier to treat, has lesser morbidity, and better outcome. There is lack of awareness about breast cancer screening among both the public and healthcare professionals. Hence, it is of paramount importance to effectively disseminate information about SBE, other breast cancer screening methods, risk factors and the treatment.
Multidisciplinary treatment
The treatment of breast cancer is multidisciplinary. Surgery is the mainstay of management, which can be either a breast conserving surgery or complete removal of the breast along with removal of lymph nodes from the armpit. Depending upon the type and stage of breast cancer, surgery is either preceded or followed by a combination of chemotherapy or targeted therapy or hormonal therapy. Most of the patients require radiation therapy as a part of the treatment protocol. In recent times, there have been significant advances in the systemic therapy for breast cancer, particularly the targeted therapy and immunotherapy, which has led to improvement in survival of this disease.
The beacon of hope shines bright on the fact that breast cancer is preventable and can be diagnosed early. Proactive preventive measures against breast cancer include breastfeeding for at least six months, an active lifestyle with regular exercise, and weight management and staying away from alcohol and tobacco. The key lies in early detection. With increased awareness, improved access to healthcare, and advancements in research, we can look forward to a future where breast cancer is no longer a formidable foe but a conquerable challenge.
Let’s step up our fight against cancer.
Dr Seema Gulia is professor, department of medical oncology, Tata Memorial Centre, Mumbai; and Dr Vandita Pahwa is in-charge preventive oncology, Homi Bhabha Cancer Hospital and Research Centre, New Chandigarh, Tata Memorial Centre, Punjab.
Rohit Malhotra is a medical expert and health journalist who offers evidence-based advice on fitness, nutrition, and mental well-being. His articles aim to help readers lead healthier lives.
