Bengaluru has the third highest number of breast cancer cases each year, after Delhi and Chennai according to the Population-Based Cancer Registry. Shockingly, pre-menopausal women are more susceptible, with the disease detected even in women in their early 20s and 30s. Worse, doctors say that most of the cases they treat are in the advanced stages despite the fact that technological advances have made biopsies less invasive and treatment more effective. Sustained efforts like making an annual mammogram mandatory could help with awareness and prevention, says Joyeeta Chakravorty
It may be high on gymming and fitness regimes, but it appears IT city, Bengaluru, has still a lot of catching up to do in preventive healthcare in some areas as despite the rising number of breast cancer cases among its women not many are bothering to go in for the advised regular screening that can help in early diagnosis and effective treatment.
Going by the Population-Based Cancer Registry, Bengaluru currently ranks third after Delhi and Chennai in the number of breast cancer cases among its people and sees around 1200 fresh cases added to the count every year.
What is more worrying is that the disease is being seen with more frequency among young women today. Ms Kanchan Naikawadi, preventive healthcare specialist, Indus Health Plus, reveals that breast cancer is being detected even among women in their early twenties to early thirties these days. “In recent years the average age of women with breast cancer has decreased. It is estimated that Indian women 10 years younger than their US or European counterparts are coming down with the disease,” she says.
Unfortunately, doctors believe the numbers are about to go up. "The numbers are huge even now as they show that one-third of all the female cancer cases are breast cancer, which is the biggest killer in urban areas. Sadly, we expect the numbers to go up from 1200 new cases a year to 2000 a year by 2020," says Dr C Ramesh, professor, and head of the Department of Epidemiology and Biostatistics, , Kidwai Memorial Institute of Oncology in the city, which treats around 900 fresh cases of breast cancer every year.
What is shocking is that despite this huge number women still don’t seem to take the need for breast examination seriously. The National Family Health Survey (NFHS-4) reveals that only seven per cent of urban women in the age group 15 to 49 have ever undergone a breast examination.
Not surprisingly, the diagnosis is left too late in many cases. Dr Ramesh says most of the cases that walk into Kidwai are in advanced stages. Dr Anthony Pais, co-founder and clinical director and head of the breast cancer unit at Cytecare Hospital too reveals that most of the patients, who walk into his hospital also arrive with Stage 2 or 3 tumours.
“On an average we see around 30 to 60 old and new cases every month and the most common age group is 47 years. The maximum number of women coming to us with breast cancer are between 45 and 50 years old,” he adds.
Stressing the importance of regular medical check-ups, including mammograms, Dr Basawantrao Malipatil, consultant, medical oncologist, Columbia Asia Hospital, Whitefield, reveals that it detected around six cases of breast cancer over the last two years in the course of such routine examinations. “Most of them were incidentally detected when these women came for a regular health check-up,” the doctor adds.
In fact, Dr Pais suggests that every woman who is over 40 should have a clinical examination once in two years and those with a family history of breast cancer should go in for an annual check-up just to be on the safe side.
New treatments can increase chances of being cured by upto 90 per cent
The good news is that today with improved screening and more effective and tailored treatments the lump in the breast can be tamed if detected early enough.
"There is technology that aids in better screening and diagnosis. Breast Tomosynthesis has been found to be 30 per cent more accurate than the standard mammogram and also 50 per cent less painful. It takes 18 pictures in one minute making it nearly impossible to miss the tumour. As a result women experience less anxiety and fewer biopsies," explains Dr Anthony Pais, co-founder and clinical director and head of the breast cancer unit at Cytecare Cancer Hospitals.
The 3D mammography has been shown to reduce the percentage of missed cancers by 15 per cent and more recent studies have shown about 30 per cent increased sensitivity and specificity in this disgnostic tool when compared to 2D mammography, say doctors.
Also, a genetics and genomics company, ILife Discoveries, has recently introduced a revolutionary new gene test in India to help oncologists get a deeper insight into tumours and assist them in deciding if chemotherapy can be avoided in some patients.
"The MammaPrint and Blueprint technology can help doctors reduce the use of unnecessary chemotherapy by identifying the risks and the need for it,” explains Mr Anand Gupta, founder and CMD, iLife Discoveries.
Stressing that cancer, when detected early is curable, Dr Basawantrao Malipatil, Consultant Medical Oncologist, Columbia Asia Hospital, Whitefield says while mammography has been the most common technology used to detect breast cancer for many years, those who are prone to it and have a family history undergo a BRCA gene mutation test as well. “Recently MRI and ultrasound has been proving helpful in detection, but are not routinely recommended,” he adds. Warning that as the stage increases, the chances of curability decrease with breast cancer, he says, “At Stage 1, there is 90 per cent chance of curability, in Stage 2, it is around 80 per cent, in Stage 3, it is around 60 per cent and in Stage 4, it is incurable."
Dr C Ramesh, professor and head of the Department of Epidemiology and Biostatistics at Kidwai, believes more awareness has to be created to encourage women to go in for regular screening and seek early treatment for the best results.
Lifestyle, diet can keep cancer at bay
Breast cancer, as we all know, is a lifestyle disease. There is a lot of hereditary preponderance as well when it comes to this cancer and it is important that a lot more emphasis is placed on its management and prevention. In India we are now detecting more breast cancers early thanks to our approach to the management of the disease over the last few decades,
Increased awareness and the availability of new technologies has decreased the fear of breast cancer. And rightly so, as if properly treated the first time, the results are very good.
There has been a change in the understanding of the disease and it is interesting to note that unlike in the past we no longer do any radical breast surgeries, which are minimal today.
Doing routine mastectomy is unethical and not the standard care for breast cancer anymore. It is, however, unfortunate that some surgeons are still performing it routinely.
In terms of treatment we have now moved to precision medicine as a result of better understanding of the disease, use of molecular diagnostic markers and next-generation sequencing.
One of the most important things we need to know is that obesity is probably one of the single most important reasons for breast cancer. Everyone is educated and informed about smoking and alcohol intake, but most of us are not aware that obesity is one of the most important causes for the rising incidence of this cancer in India.
Awareness is the key here as people need to have adequate nutrition and fluids and do regular exercise as a preventive measure.
They should also work towards fighting stress, pain, anxiety, depression and exhaustion much more.
Everyone should schedule regular and timely appointments with their doctor, undergo all routine tests from time to time, have a healthy diet, do regular exercise and have a positive outlook as this too definitely helps.
Dr B.S. Ajaikumar,
Chairman and CEO, HCG Enterprises Ltd