“Every woman needs to know the facts. And the fact is, when it comes to breast cancer, every woman is at risk”- Debby W. Schultz.
Come October, and it’s raining pink, the month for breast cancer awareness. Yes its pink, the colour most commonly associated with femininity. The colour which symbolizes love, warmth & nurturing, is most aptly chosen to universally mark the campaigns of breast cancer awareness.
Breast cancer is fast gaining prominence in India. It is at present the most common cancer in Indian women accounting for 25-31%. According to an ICMR research, in India every 1 in 28 women develop breast cancer during their life time. Cervical cancer which once dominated the Indian scenario has now been left behind by breast cancer in terms of both incidence and mortality. Currently, India is experiencing an age shift and the average age of developing breast cancer has shifted from 50 – 70 years to 30 – 50 years; and cancers in the young tend to be more aggressive. 
It is difficult to outline the exact causes of the breast cancer. However, an elaborate research has led to the identification of the risk factors to a certain extent. The unmodifiable risk factors include advancing age, a strong family history of breast cancer especially in 1st degree relatives such as mother, sister, daughter, any previous history of breast cancer, ovarian cancer or even relatively benign breast lumps. The genes responsible for the familial trend are BRCA1 and BRCA2. About 1 woman in 200 carries the genes which predispose a woman to breast cancer but does not ensure its occurrence.
Breast cancer is fast gaining prominence in India. It is at present the most common cancer in Indian women accounting for 25-31%. According to an ICMR research, in India every 1 in 28 women develop breast cancer during their life time.
Scientists have reported that the prolonged exposure to estrogen (female hormone) is a major risk factor for the development of breast cancer. Early age of menarche (<12years), late menopause (>55yrs), irregularities in the menstrual cycle (deviation from the average 26-29 days), delayed first child birth(>30ys),lack of breast feeding, use of Oral Contraceptive Pills(OCPs), Hormone Replacement Therapy(HRT) for the post-menopausal women; all these increase the exposure to estrogen. Estrogen which is the female hormone causes the cell division. An excess of exposure leads to greater cell division which increases the probability of these cells to undergo any malignant change. Obesity and alcohol consumption are factors which contribute to the disease as well. Exposure to high doses of radiation is also a risk factor. A common factor noticed is that all these factors are related to urbanization. Hence, breast cancer is called a life style disease. This statement is further substantiated by the analysis which shows that in urban areas 1 in 22 suffer from breast cancer when compared to rural areas where the ratio is 1 in 60.
Clinical manifestation of breast cancer is variable. It usually presents a painless rapidly growing lump in the breast or in the underarm. Sometimes the lump is too small to be felt as usually detected on the mammogram. A point to be remembered is that not all lumps are malignant. Any change in the size, shape and texture of the breast should not be ignored such as tenderness in the breast, flattening or indentation of the breast, orange peel like appearance, induration and ulceration. Nipple Retraction, dimpling, itching, a burning sensation, ulceration, scaly rash and discharge (clear/blood stained/abnormal) should be immediately brought to the notice of a doctor.
As a preventive strategy life style modifications, a regular Breast Self Exam(BSE) and an annual mammography screening for women above the age of 50 years can be done. Any abnormalities in the breast or the nipple should be immediately reported to the doctor and the triple assessment- Clinical, Radiological and Cytological should be sought.
However in developing countries like India, where illiteracy breeds ignorance, such practices are not encountered as frequently as in the Western countries. GLOBOCAN PROJECT of 2012 reported that India has topped the charts for deaths due to breast cancer . The root evil for this high mortality rate is ignorance of the disease. Awareness and understanding of this disease is half the war won already as an early detection leads to an early & appropriate treatment thus ensuring a better prognosis.
Popular awareness activities have now been initiated in India as well. These include marathons, walkathons, merchandise, seminars & programs, and of course the pink selfie which is the latest addition to the bandwagon of PINK RIBBON CULTURE. However, these activities have only been successful in sensitizing the urban population. Very little is being done on the rural set up which constitutes almost 70% of the Indian population. Now, breast cancer has become the 2nd most common cause of death in the rural areas. Hence the significant proportion of women suffering and dying due to breast cancer in the Indian villages cannot be ignored.
The major hurdle lies in educating the masses of the rural areas about a disease which is still considered to be a cultural taboo. The rural society is dominated by illiteracy and poverty, where the women are reluctant about discussing such problems and delay visiting the doctor. Additionally, a family in which the woman suffers from a disease such as breast cancer is socially outcast and has a negative bearing on the lives of the other female folk.
The solution to this problem is not simple. It requires an intensive approach marked by dedication. The approach has to be extensively implemented in order to get substantial results. It has to encompass all the strata of the society in order to ensure significant sensitization of the issue.
Now, breast cancer has become the 2nd most common cause of death in the rural areas. Hence the significant proportion of women suffering and dying due to breast cancer in the Indian villages cannot be ignored.
It is mandatory for the government to take the initiative to break the social stigma associated with breast cancer in the rural areas. A foremost step that can be taken up is conduction of regular awareness and screening camps in the rural areas. Additionally, training interested volunteers such as students from various fields so that they can carry out door-to-door promotion. Counselling the women and their families about breast cancer should be done on a regular basis in the PHCs and hospitals. The awareness program should be aimed at educating an illiterate woman about recognizing any unusual changes in her body as well as conducting a regular Self Breast Exam every month 4-5 days after her menstrual cycle. BSE although not scientifically proven to be efficacious is still considered to be a useful tool in developing countries like India where there is a lack of screening programs. The entire family should be involved in the process of imparting awareness about the disease and should be encouraged to support the women of the house.
The electronic and paper media should be utilized for the promotion and famous celebrities as well as local religious and political leaders should be included in this strategy in order to make the message more impactful.
Busting of the myths associated with breast cancer and increasing the tolerance of the society towards women suffering from this disease will definitely encourage the women to approach the doctors at a much earlier stage thus significantly improving the outcome of the disease.
Lastly, a systematic cancer registry which is implemented in only a handful of states should be maintained for every state in the country in order to understand vital statistics such as case detection.
1. National Cancer Registry Program, Indian Council of Medical Research PBCR 2009-2011
2. American Cancer Society: “Learn about Cancer: Breast Cancer.
3. “National Cancer Institute: “Breast Cancer.”
4. CDC: “Breast Cancer.”
5. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide 2012
Featured image source: http://www.rudyard.org/breast-cancer-ribbon-background-desktops/