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Breast Cancer: Challenges and Opportunity
Context:
Breast cancer is now the most common cancer among Indian women, previously the fourth most common in the 1990s. Every four minutes, a woman is diagnosed with breast cancer in India, highlighting the increasing prevalence.
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- Over the next 10 years, 50,000 additional women per year are expected to require treatment.
- The financial burden is substantial, with an estimated yearly cost of US$19.55 billion.
Contributing and Risk Factors
- Gender: 99% of cases occur in women, and 0.5–1% in men. About 50% of women diagnosed have no identifiable risk factors other than being female and over 40 years old.
- Other Risk Factors: Increasing age, obesity, alcohol use, family history, radiation exposure, reproductive history, tobacco use, and postmenopausal hormone therapy.
- Women in India are diagnosed at younger ages compared to Western countries, which makes the disease more aggressive in younger women with higher risks of relapse and metastasis.
- Genetic Factors: Mutations in BRCA1, BRCA2, and PALB-2 genes increase the risk significantly. Women with these mutations may opt for preventive measures like mastectomy or chemoprevention.
Statistics in India (2019-2023)
- The number of breast cancer cases increased from 200,218 in 2019 to 221,579 in 2023.
- Deaths from breast cancer increased from 74,481 in 2019 to 82,429 in 2023.
- Mortality rates are rising, suggesting issues with early detection, treatment access, and management.
Challenges in Breast Cancer Management in India
- Late Diagnosis and Low Awareness: 60% of cases are detected at stages III or IV.
- NFHS (2019-2021) data: Only 0.9% of women (30-49 years old) have undergone screening.
- Lack of awareness about symptoms and the importance of regular screenings. Cultural taboos and social stigma discourage early medical intervention.
- Inadequate Screening Infrastructure: Limited availability of mammography facilities, particularly in rural areas. High breast density in Indian women affects mammography sensitivity, leading to misdiagnoses. Shortage of trained healthcare professionals and diagnostic centres.
- Financial Barriers to Treatment: Treatment costs range from INR 100,000 to INR 1,000,000 or more. High out-of-pocket expenses and inadequate insurance coverage lead to high dropout rates.
- 95% of advanced cancer treatment facilities are located in metropolitan areas, leaving rural populations underserved. India has only 2,000 oncologists for 10 million patients.
- Psychological Impact on Patients: Breast cancer diagnosis triggers anxiety, depression, fear, and grief. Disruptions to daily life, financial stress, and family burden further affect mental well-being.
Opportunities for Improvement
- Awareness Campaigns and Public Health Initiatives: Campaigns like “Pink Month” help spread awareness and encourage screenings. School and workplace awareness programs can educate women early. Government and NGO collaborations for community outreach initiatives.
- Expanding Medical Training and Infrastructure: International School of Oncoplasty (ISOS) & University of East Anglia (UEA) partnership to enhance breast cancer management training in India.
- Fellowship programs to improve surgical outcomes and encourage breast conservation.
- Advancements in AI and Technology: AI-driven diagnostic tools like “MammoAssist” enhance mammography accuracy. AI helps detect patterns in MRI scans, ultrasounds, and mammograms, improving early diagnosis.
- Grassroots Healthcare Programs: Breast Health Initiative (BHI) trains community health workers (ASHAs) and auxiliary nurses to conduct clinical breast examinations. Improves early detection, especially in rural and underserved regions.
- Policy and Healthcare Reforms: Implementation of comprehensive national cancer care policies to ensure equitable access. Increased investment in screening infrastructure, trained personnel, and advanced treatment technologies.
WHO Response
- Global Breast Cancer Initiative (GBCI): Aim to reduce global breast cancer mortality by 2.5% annually, preventing 2.5 million deaths from 2020-2040. By 2030, the initiative hopes to prevent 25% of breast cancer deaths, and by 2040, 40% among women under 70.
- Key Pillars:
- Health Promotion: Public education on early detection and awareness of symptoms.
- Timely Diagnosis: Encouraging early consultations even without mammographic screening.
- Comprehensive Management: Improving access to treatment in resource-limited settings.
What is Breast Cancer?
- Breast cancer occurs when abnormal breast cells grow uncontrollably, forming tumours. If untreated, these tumours can spread and become fatal.
- Types: Cancer typically starts in the milk ducts or milk-producing lobules of the breast. Early-stage (in situ) cancer is not life-threatening, but invasive cancer can spread to nearby tissues or lymph nodes, leading to metastasis.
- Symptoms: Advanced breast cancer can include:
- Breast lump or thickening
- Change in size, shape, or appearance of the breast
- Skin changes (dimpling, redness, pitting)
- Nipple changes (appearance, fluid discharge)
- Breast cancer can spread to nearby lymph nodes and organs like the lungs, liver, brain, and bones, causing symptoms like bone pain or headaches.
- Treatment Options:
- Surgical Treatment: Lumpectomy (removal of the cancerous tissue) or mastectomy (removal of the whole breast). Lymph nodes may be removed to check for spread.
- Radiation Therapy: To reduce recurrence risk and treat residual cancer cells.
- Medications: Hormonal therapies (e.g., tamoxifen, aromatase inhibitors) for hormone receptor-positive cancers.
- Chemotherapy for hormone receptor-negative cancers and advanced stages.
- Targeted biological therapies (e.g., trastuzumab) for HER-2 positive cancers.
- Sentinel Node Biopsy: Preferred over full axillary dissection to check cancer spread with fewer complications.
- Effectiveness: Early and complete treatment is crucial for better outcomes.
