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October being the Breast Cancer awareness month, we thought that a discussion on breast cancer in India would be most appropriate to start the IBPS blog. Breast cancer is the most common female cancer worldwide representing nearly a quarter (25%) of all cancers with an estimated 1.67 million new cancer cases diagnosed in 2012. In India, although age adjusted incidence of breast cancer is lower (25.8 per 100,000) than UK (95 per 100,000), mortality is still at par (12.7 vs 17.1 per 100,000) with UK . This fact points out that India is literally heading towards the breast cancer epidemic. The question of the hour is “Do we have the awareness and tools to really prevent one?’
Although genetic testing for breast cancer risk has increased, doctors say that disease awareness is still very low. According to a study published in the Journal of Business Research in August this year (2017), 70,000 Indian women died of breast cancer by 2012 and deaths from this disease are predicted to increase over 76,000 in 2020. Impulsively, with an average age of incidence shifting to 30 years from 50 years.  Due to lack of proper cancer registry, the number can be further high. Access to treatment, and not-detection, can take the numbers much higher. Yet, women seek medical care extremely late-stage of this disease which is due to lack of awareness about self-examination and cultural barriers. The study found that traditional marketing campaigns don’t work for raising awareness of the disease and that community nurses are the most effective channel. A greater understanding by men is also key to tackling early diagnosis. Like all cancers, breast cancer too, if detected early can be cured with chemotherapy and through surgery.
Globally, about 10% of breast cancer is genetic or due to an inherited DNA mutation. But a recent study suggests that there may be a greater occurrence of genetically-linked breast cancer among Indian women. The study by Strand Life Sciences, a company specialising in precision medicine, in collaboration with the Indian Institute of Science in Bengaluru and other institutions, published last year in the Journal of Human Genetics, signifies that, Indian women have more BReast CAncer gene (BRCA gene) mutations than women in western countries. This indicates that women and even men who have family histories of breast cancer should have access to the BRCA genetic test to gauge their predisposition to the disease. A patient who knows his or her predisposition to breast cancer can choose how often to get tested for the disease and the choice of treatment if he or she develops the disease. Breast cancer survival has improved because of the recent developments in diagnosis, especially the shift from using mammograms to using blood tests since mammograms often throw up false positives for the disease. However, the guidelines used in India so far to screen for breast cancer are not adequate to deal with the growing burden of the disease as India follows protocols that were prescribed by other agencies such as American Congress of Obstetricians and Gynaecologists and the Royal College. High risk patients can be sent for genetic counselling and screening for BRCA1but factors governing this are the cost of testing (BRCA testing costs around 15,000-35,000 INR) as also the unwillingness to know what lies in the future. At the same time, it is also important for doctors to become more attuned to looking for breast cancer. According to a senior oncologist who sees an average of 25 breast cancer patients every month, clinicians need to be more aware and should counsel their patients more often. A pragmatic step will be to make it mandatory for incorporating mammograms and blood test through state sponsored annual health check-up.
Saavdhaan India! Let’s join hands to protect women from breast cancer.
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