Ruchi is a vivacious 23 year old, who works for a leading PR firm. It is only 7 a.m. and she’s up and ready to go for her first quarterly check-up. She’s nervous because she, “….can’t imagine having to go through another surgery.” As any other young person, she would generally never get herself checked because she thought she, “was too young to develop or acquire any serious disease.” This attitude among young women, she feels, is one reason why breast cancer is diagnosed at advanced stages.
However, according to doctors, age has nothing to do with breast cancer anymore. There are many other girls like Ruchi. The youngest breast cancer patient to have visited Dr Kanika Sharma, a senior consultant of radiation oncology at the Dharamshila Narayana Hospital, in the last few years was just 18 years old. It has become increasingly common for younger women to be diagnosed with breast cancer these days, she said.
The increasing incidence rate of breast cancer, especially among younger women in India, is an alarming trend that has emerged in the recent years. The Indian Council of Medical Research found that an estimated 1.5 lakh new cases of breast cancer were reported in 2016, making it the most common cancer among Indians. Additionally, a study published in European Journal of Cancer stated that the age of incidence of breast cancer in India is 10 years younger than that of the women in the US. So while the average age of diagnosis of breast cancer for women in the US would be 45 years, the average age of diagnosis in India is around 35 years.
Sharma attributes this to a variety of factors; especially a passive lifestyle. “The passive lifestyle that an average Indian has is taking a huge toll on their health. Consumption of junk food and alcohol and smoking are responsible for the growth in the incidence rate since they interfere with and cause damage to the hormonal balance. Another factor that has been linked with breast cancer is menarche (first occurrence of menstruation) at a younger age. Moreover, it isn’t uncommon for women these days to get married in their 30s and subsequently have a child in the following years. This is also one contributing factor that puts women at a higher risk of having breast cancer. Many young mothers avoid breastfeeding. And breastfeeding is a protective factor,” she said.
Opel Rawat, 37, nursing officer at a government hospital, was 35 when she was diagnosed with an advanced stage breast cancer. Despite being a nursing officer herself and repeatedly being told by her colleagues that the lump might be a sign of cancer, she didn’t get her mammography done. She couldn’t get herself to believe that the lump could be cancerous because there was no trace of cancer in her family history.
It was only after the diagnosis that she, “connected the dots and realised that all the signs were present already.” Opel had her first child at the age of 32 and had previously been administered artificially synthesised estrogen as part of an infertility treatment that she had undergone; both factors have been found responsible for increasing the vulnerability of women to breast cancer.
NGOs working for the cause have found that most women aren’t aware of the symptoms of breast cancer. Additionally, in case such symptoms arise, they don’t know which doctor to see. Most women go to a gynaecologist, who seldom succeed at recognising the symptoms, when they should ideally be visiting a surgeon. In a lot of cases, it was found that women were discouraged by their doctors from getting a mammography done thinking that the lump formed was only a swollen lymph node.
However, not all breast cancer patients manage to survive. A study published in the medical journal, Lancet, found that in the United States only 1 out of 5 women newly diagnosed with cancer died. On the contrary, India represents a dreary picture on the survival parameter of breast cancer patients; only 1 out of 2 women newly diagnosed with cancer survive over 5 years.
The grim state of survival rates among cancer patients, in general, and breast cancer patients, in particular, majorly has to do with detection of cancer at an advanced/ later stage. Sharma blames ignorance and tabooization of the disease for this.
“Almost 70% people come to us when they’re in the third stage and not much can be done at this stage. India is just as well equipped as the US to treat cancer, provided patients turn up in the lag phase (or earlier stages),” she added. Other responsible factors are the lack of regular screenings for any tumor-like growth and low prioritization of health among women.
According to Asia-Pacific Journal of Clinical Oncology, breast cancer projection for India suggests the number to go as high as 1797900 till 2020 with more and more younger women being diagnosed with the disease.
With the current projections in sight and the dismal state of awareness among women, breast cancer is a major challenge that stands strong in the face of India unless the diagnosis and treatment facilities are strengthened and awareness increased.