‘I Didn’t Want To Wait For Cancer’
Dr Pragnya Chigurupati champions genetic testing as a game-changer in breast cancer prevention—spotting risk before symptoms appear
By : Swati Sharma
Update: 2025-07-30 16:08 GMT
India’s breast cancer numbers are rising—but the real danger may lie in what we don’t know. With hereditary cancers often going undetected due to poor awareness and access, doctors like Dr. Pragnya are speaking out. Her story of choosing preventive mastectomy after testing positive for the BRCA1 gene puts a deeply personal face on a growing public health issue.
Q When did you first learn about your BRCA1 carrier status, and what was your initial reaction?
I found out a few years ago while training in breast oncology at Tata Memorial Hospital. I got tested after understanding the importance of genetic screening and family history. I tested positive, but since I was young, I didn’t act immediately. My first instinct was to get my family tested—my mother was also positive, and my sister likely is too, since we’re identical twins.
Q What influenced your decision to finally undergo preventive mastectomy?
Two things. One, I’ve seen women in their 30s and 40s, many with young children, diagnosed and struggling with treatment. One mother said she avoided hugging her child during chemo. That really struck me. Second, I’ve seen positive results and optimism in women I’ve treated with reconstruction. I didn’t want to take chances — I wanted to be proactive.
I found out a few years ago while training in breast oncology at Tata Memorial Hospital. I got tested after understanding the importance of genetic screening and family history. I tested positive, but since I was young, I didn’t act immediately. My first instinct was to get my family tested—my mother was also positive, and my sister likely is too, since we’re identical twins.
Q What influenced your decision to finally undergo preventive mastectomy?
Two things. One, I’ve seen women in their 30s and 40s, many with young children, diagnosed and struggling with treatment. One mother said she avoided hugging her child during chemo. That really struck me. Second, I’ve seen positive results and optimism in women I’ve treated with reconstruction. I didn’t want to take chances — I wanted to be proactive.
Q How long did it take to make the decision?
It took a few years. I waited until I completed my family—I have two boys and breastfed them. Once I was done with childbearing, I felt ready. I also had years of anxiety and fear while carrying this knowledge. Professionally and personally, it felt like the right time.
It took a few years. I waited until I completed my family—I have two boys and breastfed them. Once I was done with childbearing, I felt ready. I also had years of anxiety and fear while carrying this knowledge. Professionally and personally, it felt like the right time.
Q Did your medical background help in your decision-making?
Absolutely. Being in this field helped me understand my options better. I made a very informed decision at a time that was right for me and my family. I didn’t rely on other people’s stories—it was my personal and medical call. My husband was my main support system.
Absolutely. Being in this field helped me understand my options better. I made a very informed decision at a time that was right for me and my family. I didn’t rely on other people’s stories—it was my personal and medical call. My husband was my main support system.
Q What emotional moments stood out during this journey?
That patient who wanted a mastectomy just so she could hug her child after surgery—that moment stayed with me. I didn’t want to go through that myself.
Q How did your colleagues react?
I didn’t tell many people before the surgery. Afterward, my team was incredibly supportive. The breast oncology community especially understood the significance of my choice. I also had support from a few close medical friends who guided me emotionally.
That patient who wanted a mastectomy just so she could hug her child after surgery—that moment stayed with me. I didn’t want to go through that myself.
Q How did your colleagues react?
I didn’t tell many people before the surgery. Afterward, my team was incredibly supportive. The breast oncology community especially understood the significance of my choice. I also had support from a few close medical friends who guided me emotionally.
Q How has this experience changed how you counsel patients?
I now insist that patients receive genetic counselling before testing. When I tested, I didn’t have proper counselling and carried a lot of anxiety. This experience has made me more empathetic and structured in how I guide others.
Q What would you say to someone considering surgery?
Choose a doctor you’re completely comfortable with—this kind of surgery isn’t very common in India. With proper guidance and rehab, recovery is very manageable. It's not as physically debilitating as people fear, but mental acceptance is key.
I now insist that patients receive genetic counselling before testing. When I tested, I didn’t have proper counselling and carried a lot of anxiety. This experience has made me more empathetic and structured in how I guide others.
Q What would you say to someone considering surgery?
Choose a doctor you’re completely comfortable with—this kind of surgery isn’t very common in India. With proper guidance and rehab, recovery is very manageable. It's not as physically debilitating as people fear, but mental acceptance is key.
Q What is the BRCA1 gene and how common is it in India?
BRCA1 mutations increase the risk of breast and ovarian cancer. Globally, 1 in 400–800 people carry it. In India, it's 1–3% of the population, maybe higher in some communities. Unfortunately, awareness is very low.
Q What are the biggest barriers to early detection in India?
Lack of awareness, limited access to genetic testing, cultural taboos, and the fact that many don’t know their family medical history. Even explaining what a mammogram is can be difficult, so you can imagine how hard it is to explain genetic testing.
BRCA1 mutations increase the risk of breast and ovarian cancer. Globally, 1 in 400–800 people carry it. In India, it's 1–3% of the population, maybe higher in some communities. Unfortunately, awareness is very low.
Q What are the biggest barriers to early detection in India?
Lack of awareness, limited access to genetic testing, cultural taboos, and the fact that many don’t know their family medical history. Even explaining what a mammogram is can be difficult, so you can imagine how hard it is to explain genetic testing.
Q What surprised you the most about recovery?
Physically, it took longer than I expected, especially stamina. I’m still in rehab. Emotionally, I was stronger than I thought I’d be. I had a great support system, which made all the difference.
Physically, it took longer than I expected, especially stamina. I’m still in rehab. Emotionally, I was stronger than I thought I’d be. I had a great support system, which made all the difference.
Q What advice do you have for others with a strong family history of breast cancer?
Talk to a breast oncologist or genetic counsellor. Get the right guidance, understand your options, and make a decision that suits your life and values. Early detection and prevention are key. Self-exams, regular checks, and the right doctor matter a lot.
Talk to a breast oncologist or genetic counsellor. Get the right guidance, understand your options, and make a decision that suits your life and values. Early detection and prevention are key. Self-exams, regular checks, and the right doctor matter a lot.
Not for Everyone
Experts caution that genetic testing isn’t for all. “Routine testing is not necessary for everyone. Individuals without a personal or family history suggestive of a hereditary cancer syndrome typically do not require BRCA genetic testing,” says Dr Ajesh Raj Saksena, Senior Consultant Surgical Oncologist, Apollo Hospitals.
“In such cases, the probability of identifying a clinically significant mutation is low, and the results are unlikely to alter medical management. It is important to note that only 5–10% of breast cancers are hereditary. Therefore, routine genetic screening in the general population is not recommended and should be guided by risk assessment,” he adds.
However, in high-risk groups, the benefits are clear. “Genetic testing in selected high-risk individuals allows for early identification of these mutations, enabling timely and individualised surveillance, offering preventive strategies such as prophylactic or risk-reducing surgery, and access to targeted therapies like PARP inhibitors. It also facilitates cascade testing in families, helping identify other at-risk individuals who may benefit from preventive care,” says Dr Saksena.
Red Flags in Family History
Experts caution that genetic testing isn’t for all. “Routine testing is not necessary for everyone. Individuals without a personal or family history suggestive of a hereditary cancer syndrome typically do not require BRCA genetic testing,” says Dr Ajesh Raj Saksena, Senior Consultant Surgical Oncologist, Apollo Hospitals.
“In such cases, the probability of identifying a clinically significant mutation is low, and the results are unlikely to alter medical management. It is important to note that only 5–10% of breast cancers are hereditary. Therefore, routine genetic screening in the general population is not recommended and should be guided by risk assessment,” he adds.
However, in high-risk groups, the benefits are clear. “Genetic testing in selected high-risk individuals allows for early identification of these mutations, enabling timely and individualised surveillance, offering preventive strategies such as prophylactic or risk-reducing surgery, and access to targeted therapies like PARP inhibitors. It also facilitates cascade testing in families, helping identify other at-risk individuals who may benefit from preventive care,” says Dr Saksena.
Red Flags in Family History
Some signs that may point to a hereditary risk include:
l Breast cancer diagnosed before the age of 40
l Multiple first-degree relatives (mother, sister, daughter) with breast or ovarian cancer, especially across generations
l Male breast cancer in the family
l Individuals with both breast and ovarian cancer
lTwo or more primary cancers in the same person
l Known BRCA mutation in a close relative
l Breast cancer diagnosed before the age of 40
l Multiple first-degree relatives (mother, sister, daughter) with breast or ovarian cancer, especially across generations
l Male breast cancer in the family
l Individuals with both breast and ovarian cancer
lTwo or more primary cancers in the same person
l Known BRCA mutation in a close relative