Wake-up call on breast cancer in India

NEW DELHI - In the seemingly tranquil radiation room of the All India Institute of Medical Sciences (AIIMS), two women lit up the ambience with their humour and telltale signs of victory as they shared a common experience: recovering from breast cancer.

Gauri Devi, 50, and Meenakshi Sharma, 48, (names changed) call themselves victors, as they recuperate with a chemotherapy that followed breast cancer, the second leading cause of cancer-related deaths in Indian women after cervical cancer.

“I had lumps in the armpit after which I consulted a local doctor,” said Sharma, a Delhi-based entrepreneur. “I feel I was lucky to reach doctors at the right stage. But the situation could have been better if I had known the symptoms of the disease earlier.”

Late detection and lack of awareness are a major problem in India where one in 22 women is likely to develop breast cancer, according to the Indian Council of Medical Research (ICMR). The figures are significant at a time when the world is marking October as breast cancer awareness month.

“Lack of awareness is the major problem we are facing in breast cancer treatment. Women are unaware of the symptoms and causes of breast cancer,” P.K. Julka, a senior oncologist at AIIMS, told IANS.

“By the time the cancer was diagnosed in both patients, the tumour had spread to the inner chest; pus had invaded their other body parts also. It is a very life-threatening situation,” added Julka.

According to ICMR, the incidence of breast cancer is high among women in the metropolitan cities of Mumbai, Chennai and Delhi.

“Women in urban and semi-urban areas are at a higher risk of the disease because of lifestyle- related disorders. Early menarche, late menopause and the decision to have children after the 30s alter a woman’s reproductive system,” Sameer Kaul, surgical oncologist of Apollo Hospital in the capital, told IANS.

According to the National Cancer Registry Programme report, the estimated number of breast cancer cases in India in 2010 is 90,659.

The need is to have regional screening centres and parallel cancer registration programmes all across the country, say experts.

“The screening procedure includes mammography, clinical examination by a specialist and self-examination of breasts by the woman herself. It should start at the age of 40,” said Kaul.

While mammography costs around Rs.600, self-examination of breasts has to be learnt. PET scan and dedicated MRI mammography are other emerging diagnostic techniques, but are costly and not widely available in India.

The stage of diagnosis is the key factor in deciding the mode of treatment, as the disease demands multiple treatments at times.

“A breast cancer patient has to be treated with multiple therapy, which might include operation, chemotherapy, radiotherapy, hormone therapy or immunotherapy. A right combination and sequence of different modalities of treatment are required,” said Julka.

The patient is also thoroughly investigated to rule out the presence of metastasis or recurrence.

“We have also opted for latest techniques such as personalised treatment, where chemotherapy can be avoided. We study the genetic makeup of the patient, and the technique is emerging successfully,” Julka explained.

Cancer societies in the country are also working on awareness programmes to inform women about symptoms of the disease.

“Painless lumps in the breast or armpits, a change in the size or shape of the breast or discharge from a nipple, orange peel-like appearance of the skin over the breast are the other common symptoms of breast cancer,” said Kaul.

Heredity, age, early menarche, late menopause - after the age of 55, no children, children at a late age - are the main risk factors, say experts.

Doctors also cite warning signs for women with a family history in breast cancer.

“If there is a strong family history, breast self-examination (BSE) should begin at the age of 20-21 and mammography can be done at the age of 40, once a year,” said Kaul.

“Awareness and preventive oncology are the need of the hour. Be it rural or urban, awareness has to penetrate every region. Women need to know that there is a life after breast cancer,” Jyotsna Govil, additional secretary at the Indian Cancer Society in Delhi, told IANS.

“Women need psychological support from their family, as the disease can be emotionally draining,” added Govil.

“I have come out stronger after the disease. I want to take life as it comes, and take care of my children,” points out Gauri Devi.

(Madhulika Sonkar can be reached at madhulika.s@ians.in)