Breast health in India is a growing public health concern, reflecting a shift in the country’s disease burden. Breast cancer, with its rising incidence, requires focus on detection, care, and associated challenges. This article explores its landscape, early detection, treatments, and advancements in care.
Understanding Breast Cancer in India
Breast cancer is now the most common malignancy among women in India. Its incidence has significantly increased, with a 39.1% rise in age-standardized rates for females from 1990 to 2016. In 2020, it accounted for 13.5% of all cancer cases and 10.6% of all cancer deaths in India.
A distinct characteristic of breast cancer in India is its rising prevalence among younger women, with a median diagnosis age of 49 years, compared to 62 years in Western populations. This trend is influenced by changing lifestyles associated with urbanization, including dietary changes, reduced physical activity, and increased alcohol consumption.
Reproductive patterns also contribute, with delayed childbearing and reduced breastfeeding rates recognized as risk factors. Genetic predispositions, such as BRCA1 and BRCA2 gene mutations, are also implicated, with studies indicating a notable percentage of cases having a family history. The overall shift from infectious to non-communicable diseases underscores breast cancer’s increasing public health significance in India.
Importance of Early Detection and Screening
Early detection of breast cancer is important for improving patient outcomes in India, where most cases are diagnosed at advanced stages, leading to poorer survival rates compared to Western countries. The 5-year overall survival rate is around 95% for stage I patients, but drops to 21% for stage IV patients.
Various screening methods facilitate early detection. Breast self-examination (BSE) involves women regularly checking their own breasts for abnormalities, promoting breast awareness. Clinical breast examination (CBE), performed by trained healthcare workers, is a simple, inexpensive, and practical screening tool in India. This method also provides an opportunity for healthcare providers to educate women on breast health.
Mammography, while effective for detecting impalpable cancers, faces accessibility challenges in India due to high costs and quality assurance issues. While urban areas show improving awareness and diagnostic access, rural areas face widespread lack of awareness, limited screening access, and cultural stigma, contributing to late diagnoses. Community-based initiatives, such as door-to-door screenings and training local women, are helping to bridge this gap and increase awareness in underserved communities.
Current Treatment Approaches in India
Breast cancer treatment in India involves a multidisciplinary approach, with individualized plans based on cancer type, stage, and patient health. Surgical intervention is often the initial step, including lumpectomy (tumor removal while preserving the breast) or mastectomy (complete breast removal, especially for larger or multifocal disease). Reconstructive procedures are also available post-mastectomy.
Chemotherapy, using strong medicines to kill cancer cells, is frequently administered either before surgery (neoadjuvant) to shrink tumors or after surgery (adjuvant) to eliminate remaining cells and reduce recurrence risk. Radiation therapy, using targeted energy beams, is commonly employed after surgery to destroy residual cancer cells and lower recurrence chance. However, its availability can vary due to limited dedicated units and cost.
Hormone therapy is a common treatment for hormone receptor-positive breast cancers, accounting for 60-70% of cases in India. Medications like Tamoxifen block estrogen’s effects, while Aromatase Inhibitors such as Letrozole reduce estrogen production in postmenopausal women. Targeted therapies, like Trastuzumab for HER2-positive breast cancer, specifically target cancer cells with fewer side effects. Newer drugs like CDK4/6 inhibitors are also used for advanced cases, and immunotherapy is an option, particularly for triple-negative breast cancer.
Navigating Challenges and Advancements in Care
Breast cancer care in India faces several challenges, often stemming from socio-economic factors and healthcare infrastructure disparities. Low awareness, particularly in rural areas, leads to delayed diagnoses and advanced-stage cancers. Social stigma associated with breast health also prevents women from seeking timely medical attention or discussing symptoms openly.
Financial burden is a significant challenge, as diagnosis, treatment, and follow-up costs can be prohibitive, leading to out-of-pocket expenses and financial distress. Geographical access to specialized care is uneven, with most advanced cancer centers in urban areas, forcing rural patients to travel. Inadequate infrastructure, including a shortage of trained oncologists and limited access to modern technologies, further compounds these difficulties.
Despite these obstacles, positive developments and advancements are occurring. Public awareness efforts are increasing through campaigns educating women about breast health and early detection. The growth of specialized oncology centers, particularly in major cities, is improving access to advanced diagnostic and treatment technologies, including robotic surgery and precision oncology. Government initiatives and NGOs are playing a growing role in providing support systems, improving access to care, and offering free or subsidized treatment through schemes like ‘Aarogyasri’ in some states. These collective efforts are gradually contributing to improved early detection rates and better overall outcomes for breast cancer patients across India.