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Fighting A Silent Epidemic

With rising incidence of breast cancer in India, women must seek facts and not delay decisions

Sarla was 32 years of age when she felt a lump in her breast. Since it was painless she ignored it; annoyingly, it refused to go away. After a week she decided to visit a gynaecologist who suggested a mammogram. A few days later, she underwent a fine needle aspiration to establish whether she had a benign or malignant tumour.

Sarla was 32 years of age

The cancer was detected early because the radiologist insisted that an ultrasound be done as well. As Sarla had dense breast tissue, little could be discerned from the mammography film which was white and opaque.

Sarla is among an increasing number of women in India’s cities – the estimate is one in 20 – who will be told they have breast cancer. This is a worldwide trend, as in the last 30 years the number of breast cancer cases among women has doubled. While alarming, it is worth remembering that part of the reason for this increase is probably the fact that women, especially the urban and more affluent, are living longer than ever before, while there is today greater awareness and wider access to medical facilities.

The worrying aspect, however, is that despite the fact that globally more women are being cured of breast cancer than ever before, for many women in India this still remains a life threatening disease. This is not only because they are diagnosed with breast cancer at a more advanced stage than their counterparts in the West, but also because they get cancer at a much younger age when detection and treatment are more challenging. If Sarla had not also been advised an ultrasound – and there are doctors who even advise an MRI – she may well have gone home thinking all was well with her.

Globally more women are being cured of breast cancer than ever before Globally more women are being cured of breast cancer than ever before

The screening tool considered the gold standard for early detection of breast cancer is the mammogram. While it works well for women over the age of 50, this is not true for those in their 40s and below for whom the harmful effects of screening may outweigh the benefits.

This is not only because of repeated exposure to radiation and a significant rise in the number of false positives but also because of over diagnosis. The latter is becoming a matter of concern in the western world where it is felt that certain types of non-invasive tumours are best left alone.

There are even those who argue that the word “carcinoma” not be used for such tumours as it invites unnecessary interventions that have both physical and psychological consequences. Studies are being conducted worldwide which, it is hoped, will in time facilitate individualised riskbased screening for younger women which is the answer.

To add to this, even after discovering a lump in the breast, women in India tend to delay investigations, thereby losing precious time. Besides modesty, there is the fear of the attendant negative social consequences. Sadly, cancer still carries a stigma in this country. People, and sometimes close family members, are quick to blame the victim. Those affected too are often ready to accept such blame. Many also worry that the stigma will extend to marriageable daughters who may find it difficult to find a suitable boy, while others feel guilty that money is being spent on expensive treatments.

Young couples whose marriages are arranged are particularly hard hit as every one weighs in with an opinion and more often than not the conclusion is that the girl already had cancer and that they have been duped by her family. Needless to say, if it is the boy who has cancer, his young wife is expected to do her duty by nursing him through thick and thin. Demand for additional dowry may now be justified in the name of treatment cost.

Given the rising incidence of breast cancer in India, there is an urgent need to educate the public about breast cancer as well as counsel couples when cancer occurs. For the majority of women, a few simple measures can significantly lower their risk: regular exercise, weight control, healthy eating (more fibre, less fat) and avoiding alcohol.

It is only a small minority of women, with a strong history of breast and ovarian cancer in the family, who need to be alert to the possibility of a mutated gene at work. Twenty per cent of Asian women appear to be at risk for getting what is called triple negative breast cancer, an aggressive form which even if caught early has a high mortality rate. It is caused by a gene that can be passed on by both fathers and mothers to sons and daughters and so no one should feel that the other is more or less culpable.

It does seem that if we are to fight breast cancer effectively it is time for women in India to seek the facts, evaluate the screening options available to them in terms of risk and benefit and not delay or compromise on decisions that affect their health. Simply put, breast cancer is an inconvenient truth that must be faced with information and support and certainly without prejudice.

The writer is founder-president of CanSupport, which has pioneered free of charge home-based palliative care services.

Source
Times of India
19 November 2013,
by - Harmala Gupta

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