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Cover Story

Going bust

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The lump on 35-year-old Pranjali Sharma's left breast was becoming more prominent by the day. Having postponed a check-up for three months, one day she finally decided to consult a doctor. A mammography confirmed her worst fears - she had breast cancer. Luckily for Pranjali, who's among the countless young women being diagnosed with breast cancer in India, it was detected early and she was put on chemotherapy.

Traditionally believed to occur mostly in elderly women above the age of 50, the disease is now springing up in the younger generation too - like Pranjali. Interestingly, many of these women do not have a family history of breast cancer, which could have made them more prone to the disease. In fact, experts say that till a decade back breast cancer was diagnosed in around 10 per 100, 000 women every year. But now it has more than doubled to 23 per 100, 000 women. In some cities like Chennai, the figures are more worrisome, with the breast cancer ratio as bad as 33. 5:100, 000. It's almost as bad in other metropolitan cities.
A recent analysis by the Indian Council of Medical Research (ICMR), spanning 24 years between 1982-2005, showed Bangalore's breast cancer cases in that period increased from 15. 8 per 100, 000 to 32. 2 per 100, 000, and Delhi's from 24. 8 to 32. 2.

So what's really causing this epidemic?

Dr G K Rath, head of India's National Cancer Registry Programme and head of department of the Rotary Cancer Centre at AIIMS, says more women today are career-oriented, because of which they marry late and deliver their first child even later (ultimately having fewer children and shorter duration of breast-feeding ). These are reasons that can be directly attributed to the spurt in breast cancer growth rates. Dr Vinod Raina, head of medical oncology at AIIMS, adds that a western lifestyle, increased consumption of fat products and obesity are additional risk factors.

Though diagnostic science in India has improved phenomenally, the conventional methods of detecting breast cancer in India have been mammography and ultrasound. Both, however, have limitations and are incapable of detecting cancer in 100 per cent of cases. Small lesions, especially, go undetected.

Experts say early detection is the key and there are 80 per cent chances of cure if correct diagnosis is made within stage 1 and 2. In India, sadly, over 50 per cent of breast cancer cases are detected only in the final stages.

The root of the problem, some say, is India's abysmally low mammography screening rates. The World Health Organisation (WHO) says less than 5 per cent women in India, aged 50-69 years, underwent screening by mammography between 2000-2003. According to WHO, there is significant evidence to show that mammography screening among women in this age group reduces mortality by as much as 25 per cent. "Among women, breast cancer is the most common cause of cancer mortality, accounting for 16 per cent of cancer deaths globally. Less than a quarter of women globally undergo breast cancer screening. In India, too, breast cancer is the most common form of cancer in women. One in 26 women in India expects to be diagnosed with breast cancer in their lifetime, " says the WHO report.

There are three things women should do to protect themselves against breast cancer, says Dr Rath. "Conduct a self examination of your breast for lumps and unusual discharge, a mammography screening once a year after you reach the age of 45 and yearly check-up by a doctor. "

Those with a family history of the disease should take the tests more regularly, as chances of them getting it increase manifold. If a woman's mother has breast cancer, her risk increases threefold. In case her sister has the cancer, the risk is doubled. About 5 per cent of breast cancers are hereditary, say experts. Two genes, namely BRCA1 and BRCA2, have been identified as the culprits.

Doctors, meanwhile, are now reporting a new trend related to breast cancer - double mastectomy (removal of both breasts). Experts say it is now becoming common, globally, even if not needed. A growing number of women diagnosed with cancer on one breast are opting to surgically remove even their healthy breast in the belief that it would reduce the possibility of the cancer coming back. In the last six years, the number of such women in the US alone rose by 150 per cent.

According to guidelines, treatment of cancer in a single breast calls for removal of the tumour and not for mastectomy. The risk of developing cancer in the second breast is actually less than 1 per cent.

Dr Vineet Gupta from Health Care Global, Bangalore, says only 10 per cent of all women suffering from breast cancer require mastectomy and the new, disturbing trend has no great scientific merit. "Mastectomy is recommended prophylactically for patients who show genetic mutations and are at high risk, " Dr Gupta says about the trend which has, thankfully, still not caught up in India.

kounteya. sinha@timesgroup. com

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