“Breast Cancer Awareness Month…helps to increase attention and support for the awareness, early detection and treatment as well as palliative care of this disease,” says the World Health Organization (WHO). “Early detection of the disease remains the cornerstone of breast cancer control. When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance that breast cancer can be cured. If detected late, however, curative treatment is often no longer an option.”
Emphasising the importance of early detection, Dr P. Raghu Ram – chief executive officer Ushalakshmi Breast Cancer Foundation and director of the Centre for Breast Diseases at KIMS-Ushalakshmi – said “women of all ages should be aware of new changes in their breasts and must report to their doctor when any changes are noticed. Women over the age of forty years should get an annual screening mammogram.”
Such messages are of great importance in India, which shoulders one of the largest burdens of breast cancer in the world. In 2018, the country reported 162,468 new breast cancer cases and 87,090 deaths among women. The disease is the most common type of cancer among Indian women and, together with cervical cancer, oral cancer, lung cancer, and colorectal cancer, accounts for 47.2 percent of the overall cancer burden in the country.
Early detection is imperative. Breast cancer often goes undiagnosed until its advanced stages where it is much more difficult to treat and prognosis is significantly worse. Almost sixty percent of breast cancer patients in India are not diagnosed until the disease is in its late stages. It is estimated that late diagnosis of breast cancer could lead to 76,000 deaths a year by 2025. This is indicative of a fatal lack of awareness surrounding the disease. Put simply, for every two women newly diagnosed with breast cancer, one will die from it.
Symptoms of breast cancer can include a lump or mass in the breast; swelling of the breast; skin irritation; pain in the breast or nipple; redness of the nipple or breast skin; and discharge excluding breastmilk. If the cancer spreads to the lymph nodes surrounding the clavicle (collarbone) or beneath the arm, it can leave a lump or mass there.
Mindfulness of these symptoms is vital and promoting awareness of them must be incorporated into public health policies. As mentioned by Dr Ram, screening in the form of mammograms is vital, particularly for women over the age of forty. Annual screening for this age group is advised by groups such as the American Cancer Society.
Another issue complicating the treatment of breast cancer is the country’s inadequate infrastructure to respond to cancer, with shortages of dedicated hospitals and beds for cancer patients and a dearth of oncologists: India presently has just 1,250 oncologists for 2.25 million cancer patients. By 2040, to cope with demand, the country will require an estimated 7,300 cancer physicians – a significant expansion given current staffing levels.
To the government’s credit, initiatives have been undertaken to expand access to screening for breast cancer. Under Ayushman Bharat, health and wellness centres have screened 54 lakh people for breast cancer. Meanwhile, efforts are underway to promote the health benefits of breastfeeding – a practice associated with a lesser risk of breast cancer in later life. Indian researchers are working in the field of breast cancer research, with one collaboration between the Indian Institute of Technology in Guwahati and the Indian Institute of Sciences in Bengaluru investigating the spread of breast cancer through the bloodstream.
What is patent, however, is that more needs to be done to improve cancer infrastructure; provisions for screening; and overall awareness of the disease, its risk factors, its signs and symptoms, and the importance of screening. October may mark Breast Cancer Awareness Month, but efforts must be undertaken year-round to raise awareness – not only in a single month.