Dr Charitha Ganagdharan
Despite improvements in treatment there is increasing incidences of breast cancers in low- and middle-income countries and causes the greatest number of cancer related deaths among women. India is under a greater threat than other countries from the west due to increased incidences of breast cancer. How can we tackle this?
Breast cancer is a global disease; however, every region has its own uniqueness for the disease although the majority of the underlying causes and other features remain the same. The most common cancer in Indian women is breast cancer. Rising incidences of breast cancer among younger women (in their thirties and forties) is being reported from India. One of the major causes of this demographic data is because India has a larger population of young age women in comparison to old women. 48% of patients diagnosed with breast cancer are in their premenopausal age and around 66% of the total population of women are in the age range of 15- 64 years. It is terrifying to find out that Indian women most often suffer from the most aggressive type of breast cancer called the triple negative breast cancer (TNBC). The tumour biology and behaviour of TNBCs are poorly understood. The other subtypes of breast cancer that express receptors to hormones like estrogen or progesterone or the human epidermal growth factor (HER 2) have targeted therapy against them and can be clinically managed. The TNBC type tumours do not express any of these. It accounts for only about 12-17% of all invasive breast cancers (cancers that are capable of spreading to other parts of the body) in the Caucasian population whereas the prevalence of TNBC in India is around 31%. Research suggests that only 5% of the breast cancer cases reported show the risk of familial inheritance of TNBCs. However, elucidation of a common genetic pattern or mutations that predisposes Indians to a higher risk is an area that still needs answers. The other major reasons that account for the increased incidence of breast cancer in general are late pregnancy, inadequate lactation or breast feeding, obesity and lack of exercise, use of tobacco and alcohol, and medical use of hormones. [1, 2 and 3]
Medical use of hormones is one of the causes of breast cancer
The survival rate of breast cancer in US and Australia is around 90%, while India continues to have a low survival rate of 66% as reported by a recent study published in a renowned journal, Lancet. Given the high burden of TNBC subtype in India, if diagnosed early, the patient has a 60% chance of extending their lifespan by five years. However, for a patient diagnosed with other subtypes of breast cancer has a 90% probability. In India, the presentation of patients for medical care is at a later stage and is more aggressive. The earlier the diagnosis, the more likely it can be treated successfully. There is an increasing demand for screening programmes, early detection and breast cancer awareness to tackle this problem. The burden of the aggressive TNBC subtype of breast cancer, lack of awareness of early signs of breast cancer and late presentation all together contribute to lower survival rate in Indian patients. [4]
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