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Wake-up Call on Breast Cancer in India

by Dr.Sania Siddiqui on  January 17, 2011 at 7:28 PM Health Watch   - G J E 4
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"Come What May, I Will Be Happy And Gay": A Cancer Patient's Story Of Will And Wit

Usually the mood in the radiation room of All India Institute of Medical Sciences (AIIMS) is tranquil and somber. But that day it was little different. Two women lit up the otherwise gloomy atmosphere with their humor and telltale signs of conquest as they shared a common experience of recovering from breast cancer and coming out as winners in life.

Prabha Rajput, 50, and Divya Sharma, 48, (names changed) call themselves "conquerors", as they recover after receiving chemotherapy that followed breast cancer.

Ms. Sharma, a Delhi-based entrepreneur, recalls the day she felt something "different and abnormal" around her armpit region as she says, "I felt some lumps in the armpit area after which, without wasting anytime I consulted a local doctor. I guess I was lucky to reach him at the right stage. But still the situation could have been much better had I known and gauged the symptoms of the disease little earlier."

Prabha's story is no different either. She also sought medical help only when the cancer has spread a little further, but thankfully not "too far" that it can not be taken care of. She points out in rather cheerful mood, "I have come out stronger after the disease and I want to take life as it comes".

According to the Indian Council of Medical Research (ICMR), lack of awareness leads to late detection and is a major problem in India, where one in every 22 women is likely to develop breast cancer at any stage of their life.

Similar views are voiced by Dr. P.K. Julka, a Senior Oncologist at AIIMS as he told IANS that, "Lack of awareness is a huge problem that we are facing in breast cancer treatment. Women are unaware of the basic symptoms and major causes of breast cancer".

Talking in regard of Prabha and Divya's case, he added, "By the time the cancer was detected in both patients, tumor had spread to the inner chest and the cells had invaded their other body parts as well. It was a life-threatening situation".

According to ICMR, the incidence of breast cancer is much higher among women living in the metro cities Delhi, Mumbai, and Chennai.
 
Dr. Sameer Kaul, Surgical Oncologist of Apollo Hospital, Delhi said, "Women in urban and semi-urban areas are at a higher risk of the disease because of their lifestyle. Apart from early menarche and late menopause, some lifestyle-related factors which contribute to the disease could be the decision to have children after the 30s or opting out of breast feeding. These can definitely alter a woman's reproductive system". 

According to the National Cancer Registry Program's report, in the year 2010, the estimated number of breast cancer cases is around 90,659.

Experts suggest that it is of utmost importance to have regional screening centers and parallel cancer registration programmes all across the country.

To this. Dr. Kaul further adds that, "The screening procedure should start at the age of 40 which should include a self examination of the breast by the women herself and mammography/clinical examination by a specialist".
 
While mammography costs around Rs.600, proper self-examination of breasts by the female is free but has to be learnt. Dedicated MRI mammography and PET scan are other emerging diagnostic techniques to get hold of the disease but are costly and not widely available in India.

The "stage of the spread" is the key factor in deciding the mode and line of treatment, as the disease demands multiple treatments at a given time. "A breast cancer patient has to be treated with multiple therapies, which might include chemotherapy, radiotherapy, operative measures, hormone therapy, or immunotherapy. A right combination and sequence of different modalities of treatment is vital and required," said Dr. Julka.

During the course, patient is also thoroughly investigated to rule out the presence of metastasis or recurrence.

"To avoid chemotherapy, we have also opted for latest techniques such as personalized treatment. In this we study the genetic makeup of the patient. This technique is emerging successfully", explained Dr. Julka.

Several cancer societies in the country are also working on various awareness programmes to teach women about symptoms of the disease.

While talking about the symptoms, Dr. Kaul elaborated, "Painless lumps in the breast or armpit region, noticeable change in the size or shape of the breast, any discharge from a nipple, orange peel-like appearance (peau-de-orange) of the skin over the breast are few of the common and noticeable symptoms of breast cancer".

Risk factor for the diseses includes heredity, age, early menarche, late menopause, no children, and children at a late age. Women with a family history of breast cancer are at higher risk.

"When there is a strong family history of the disease, regular breast self-examination (BSE) should begin as early as at the age of 20-21. Mammography can be done at the age of 40, only once a year," said Dr. Kaul.

Jyotsna Govil, Additional Secretary at the Indian Cancer Society in Delhi, told IANS,

"Awareness and preventive oncology are the need of the hour. Be it rural or urban, awareness has to penetrate every region. Women need to understand that there can be a life after breast cancer. Women need strong psychological support from their families as the disease can be emotionally draining and tormenting".

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