The first cancer to be identified in the documented history of human beings, Breast cancer, continues to be the leading cancer in women around the world and in India. Despite the giant strides in the fields of Surgery, Chemotherapy, Radiotherapy and other targeted therapies it still remains the number one killer of women, as far as Cancers are concerned, around the globe. It seems apt, then, that the word cancer was coined for this particular scourge.
A cause of dread and trepidation as it is, there are still plenty of ways to battle it, and to battle it successfully. One of the first ways is primary prevention. However, most breast cancers are not amenable to that. The most well studied and clinically effective method is screening and early intervention- also called secondary prevention.
It entails subjecting target age groups to mammography and if any suspicious lesion is found going for further testing. The data showing the effectiveness of this strategy in preventing breast cancer related deaths is robust and sound. Every country that has an organised screening program has been able to catch the disease at an early stage thereby decreasing the incidence of mortality. Most developed countries, for example, screen around 80% of their women for Breast cancer. As a result, they catch the disease in stage I or II about 80% of the time, therefore, leading to a very low mortality-incidence ratio.
India, on the other hand, screens only 1.6% of its women. That’s largely because we have no organised screening program and whatever screening we do is opportunistic. Even though self-examination could be used as an effective early detection method, social stigma, lack of awareness and pervasive influence of pseudoscience invariably lead to delayed presentation. Consequently, 50-60% of Indian women are stage III or IV at the time of diagnosis in contrast to 20% of women in advanced countries like Sweden, Norway etc. And since stage is the most important predictor of outcome, this leads to a huge difference in 10 year mortality.
Right now, there are two patients under my care who are victims of the misconceptions around the disease. One patient abandoned adjuvant chemotherapy after a breast conserving surgery and went for treatment by an alternative modality. She presented two years later with metastatic disease. The second patient has had a breast lump for 10 years, which she ignored and has now presented with widespread bony metastasis. Her cancer morphology is favourable, which explains the long survival. Had she reported earlier, though, she might have achieved a complete cure. At present, however, her prognosis remains grim.
These types of cases are a very common occurrence in India, especially the ones getting misled by the lure of nonsurgical management by alternative therapies. If we have to tackle the problem of breast cancer effectively an organised screening becomes doubly necessary. Firstly, for early stage detection and secondly, for identifying and rescuing the women who fall prey to unethical practices.
Breast cancer is a major health problem facing us. Fortunately, there is a very well standardised and effective treatment protocol available. Unfortunately for us, most Indian women are never able to access that protocol either in time or in totality. There are many more aspects to care of breast cancer patients, but the biggest hurdle is right at the beginning. It’s time we addressed it.
An Equanimous Voice 