Breast cancer is raging in India as an epidemic even though the incidence is lower compared to the west, said oncologists from the Apollo Cancer Centre (ACC), Hyderabad.

In a webinar organised by The Times of India in collaboration with ACC, Hyderabad on June 25, senior oncologists stressed the importance of early detection of breast cancer and highlighted the advancements in its treatment.

According to statistics, breast cancer constitutes 26% of all cancers diagnosed in women, said Dr TPS Bhandari, senior consultant, surgical oncologist, and oncoplastic breast reconstruction surgeon. He said, One in 22 women get breast cancer at some point in their lifetime and if diagnosed early, the cure rate is high.

Until a decade or two, it was cervical cancer that was quite common among women in the country. But, now, breast cancer cases are on the rise. It is considered a lifestyle disease and it is due to the rapid westernisation, urbanisation and adaptation of newer lifestyles, said Dr Srinivas Chakravarthy Gummaraju, senior consultant haematologist and medical oncologist.

Pointing out that the incidence of breast cancer though is less in India than in the West, he said that unlike in India, one in five women get breast cancer in western countries. But, since the population of our country is high, the proportion would also be high, he added.

Awareness and early detection

It is imperative to go for a proper screening to detect breast cancer at an early stage. According to Dr Bhandari, a one-centimetre lump is the smallest size that could be palpated in the breast which would have about one million cancer cells. Imagine, the magnitude of the problem and the chances of it spreading to other parts of the body,

He said that instead of focusing on prevention, importance should be given to early diagnosis. He said that there are two ways of diagnosing breast cancer in a woman. One is by mammogram and the second one is through a recently launched EasyCheck-Breast.

Even though it has become a standard protocol that only women are allowed inside the mammogram suite and it is done by women, still, there is a lot of hesitation among the women, he said, adding that patients are hesitant to undergo mammogram as it involves going to hospitals and speaking about their breasts to others.

In the case of EasyCheck Breast, a 5ml of blood sample is a 5 ml blood sample drawn from the patient and circulating cancer cells in the blood are detected which would identify early breast cancer.

Further, Dr Bhandari said that if breast cancer is diagnosed at stage zero where cancer has not become invasive then the cure rate is about 95 to 99% but if cancer cells spread to the nodes then the cure rate falls to 65 to 70% and if it spreads to other parts of the body, then the result is less.

The senior oncologist explained when the mammogram shows lesions that are about 2 to 4 mm in size, then one way of doing a biopsy is with the help of ultrasound. With the help of ultrasound, the lesion is localised and a true cut needle is guided into it and hits the tumour to avoid false negatives, he said.

Emphasising mammogram screening, especially for women above 40 years, Dr Bhandari said that there is no definite cut-off age to start screening for breast cancer and women with a family history of breast cancer should start screening at 30 or 35 years.

Stating that Apollo Cancer Centres were the first to introduce Positron Emission Tomography (PET) CT scan 15 years ago in India and Asia, Dr Bhandari said that the scan tells a clinician a fair amount of certainty about the stage of the disease as it evaluates the patient from hair to toe.

Fear and shyness

The oncologists also pointed out that it's not common to detect breast cancer at an early stage because most women have a mind-numbing fear and are shy too.

People usually associate cancer with pain. But it starts with a painless lump in the breast and people tend to ignore it. Also, there is a great reluctance to talk about women's bodies. When they are hesitant to talk about it to their immediate family members then how will they approach the doctors, asked Dr Gummaraju.

He insisted that women should go for screening at least once in one to three years. As mammograms are available only in Tier-1 and Tier-2 cities, the majority of women do not have access to the facility. In that case, they could undergo a clinical breast examination where a healthcare professional is trained to examine the breasts with hands. A lot of cancers could be picked up early even with this, he added.

But to find the cancer lump more effectively, clinical examination is much recommended, he added. Meanwhile, Dr Shilpa Reddy Keesara, consultant radiation oncologist, stressed the importance of clinical and self-breast examinations, especially in areas where access to mammography is less.