Breast Cancer a Growing Concern in India: Risk Factors & Prevention
While typically the incidence rates for breast cancer peak between 50-65 years, in India the incidence begins to rise in the early thirties itself.
Some of the factors responsible for this increase include lack of exercise, overweight-obesity, hormone replacement therapy, combined oral contraceptive pills and stress, among others.
It is also worrying that women in India with breast cancer tend to be diagnosed at more advanced stages when the prognosis is also poorer.
Some estimates suggest that nearly 50 percent of women with breast cancer first visit a doctor when their disease is at Stage 3.
If the disease is diagnosed early, surgery can prove to be an effective and curative intervention, however, at advanced stages, multiple interventions are usually required, including chemotherapy and radiation.
These not only make the treatment process more complex for patients who may have to contend with multiple side effects, but also increases the financial burden significantly.
Breast Cancer: Incidence Rate Across States in India
Incidence rates of breast cancer vary widely within India perhaps due to differences in the education status of women, income levels, place of residence (urban versus rural), reproductive history, lifestyle factors and participation in screening programs.
The highest incidence rates are usually observed in the north-eastern region as well as in metropolitan cities like Delhi and Mumbai.
Data released for 22 States and Union Territories as part of the National Family Health Survey-5 shows that a higher proportion of women underwent breast cancer screening in North-Eastern States like Mizoram, Manipur and Meghalaya as well as Maharashtra, Kerala and Himachal Pradesh.
Rural-urban disparities were also noted, with the majority of States and Union Territories screening more women in urban areas as compared to rural settings.
It is important to collect and analyse such statistics at the national and sub-national levels on a regular basis in order to design more targeted strategies as well as achieve greater equity in access to and quality of screening efforts.
Challenges in Tackling Breast Cancer
A major challenge in tackling breast cancer is lack of awareness, not necessarily about the disease per se, but more so about its risk factors, symptoms as well as diagnostic and treatment options.
Further, social stigma hampers the willingness and ability of women to engage in screening behaviours as well as seek diagnosis and treatment even after the appearance of symptoms.
A persistent and large-scale awareness and behaviour change campaign needs to be undertaken to encourage open dialogue on the subject as well as breast self-exams.
It is only when women are aware of how their breasts normally look and feel can they alert health providers about any noticeable differences.
Last month, the Vice President launched a national breast cancer and benign breast disease helpline, an initiative of the Ushalakshmi Breast Cancer Foundation for raising awareness.
Behaviour change campaigns can be aided by the use of technology such as periodic reminders sent to the mobile phones of women for conducting breast self-exams and minimising controllable risk factors.
Taking Charge of Breast Cancer
For women in their twenties and thirties, regular breast self-exams and clinical exams are recommended. When it comes to cancer, prevention is often not possible.
Early detection therefore becomes the next best option for maximizing survival chances alongside minimising physical, mental and financial distress for patients and their families.
For women over the age of forty years, an ultrasound scan conducted as part of the annual health check-up can help facilitate early detection.
Regular mammograms are likely to be most beneficial for women older than forty years and with a family history of breast cancer.
Those with mutations in the BRCA1/BRCA2 genes or other genetic syndromes, however, should ideally be screened at younger ages and more frequently.
Disseminating information about breast cancer and universalisation of clinical exams should be a priority intervention at the Health and Wellness Centres (HWCs) being established under the Ayushman Bharat programme.
The referral pathways for women who are deemed to require further investigation post an initial assessment at the HWCs should also be clearly defined and simplified as much as possible.
The Covid-19 pandemic has added another layer of complexity to the prevailing scenario. Outreach efforts will need to be stepped up for ensuring that women who have missed a screening are examined without further delay.
Additionally, breast cancer patients whose surgeries or other types of treatment have been postponed must be tracked by the health system and provided the necessary care at the earliest possible.
This is imperative for minimising the downstream societal and financial costs that will otherwise need to be incurred on account of breast cancer cases remaining invisible to the health system or being detected only at very advanced stages.
(Author: Urvashi Prasad, Director, Development Monitoring & Evaluation Office, NITI Aayog
Disclaimer: Views expressed are personal.)
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