As breast cancer continues to rise, several gaps need to be filled from creating awareness to early detection

Breast cancer cases continue to rise in Chennai. With the percentage of women being diagnosed late remaining high, there remain several gaps that need to be addressed, oncologists say.

According to the Tamil Nadu Cancer Registry Project Report 2021, the estimated new breast cancers in Tamil Nadu during 2021 was 11,138 with an incidence rate of 25.5 per 1,00,000 women.

“This marks an increase of 25% in the number of cases from 8,865 in 2013,” R. Swaminathan, professor and head, Department of Epidemiology, Biostatistics and Cancer Registry and Associate Director of Cancer Institute (WIA), said.

The prevalence of breast cancer was about 28,000 in 2021 in Tamil Nadu. The incidence rate of new breast cancer cases in Chennai rose from 42.9 per 1,00,000 women in 2013 to 49.8 per 1,00,000 women in 2021, according to the report.

Balaji Jegannathan, associate professor of Medical Oncology, Tamil Nadu Government Multi Super Speciality Hospital, said the incidence of breast cancer continues to be high and a large percentage of them are diagnosed in the locally advanced stage.

“We still do not see many women who are detected early. In the West, proper screening and treatment models have resulted in early initiation of treatment and reduced mortality,” he said.

Worldwide, breast cancer has been increasing steadily over the last decade, Manjula Rao, consultant-Breast Oncoplastic Surgeon, Apollo Proton Cancer Centre, pointed out.

“In the West, around 10% of women present with locally advanced or advanced cancer. However, here, more than 50-60% of women are diagnosed in the locally advanced and advanced stages of the disease. This differs in the urban and rural setting. In the urban areas, there is a little more awareness,” she said.

One of the most common factors at play is lack of awareness. “Even in an urban setting like Chennai, women are less aware of the main symptoms of breast cancer — a painless lump, skin changes or ulcer on the breast, discharge from the nipple. We need to make them aware. A painless lump is the main sign of cancer. Women aged above 40 need to get screened and undergo mammograms once a year,” she said.

V. Surendran, professor and head, Psycho Oncology, Cancer Institute, said the greater cause of concern was that more and more younger women were being diagnosed with breast cancer. There was an increasing trend from the age of 35. “Lifestyle changes, especially healthy diet and regular exercise, is essential. Second, early detection needs to be more effectively implemented,” he said.

“First, we do not have a screening programme for a highly prevalent cancer affecting women,” an oncologist in a government hospital said and added that at least one centre should be developed to take up rigorous screening for breast cancer.

“We do not have genetic work-up. We need to do genetic testing and counselling. Digital mammograms should be made the standard of care and should be installed in at least one government facility in Chennai,” he said.

Dr. Swaminathan said there definitely must be an early detection programme for breast cancer. “The existing screening programmes are done in opportunistic settings such as primary health centres. Women who utilise the services of PHCs are screened. But we should target women in urban areas as well. We should have a population-based screening giving the opportunity for all women to participate. The screening could also be linked with health insurance schemes so that no woman will defer the screening,” he said.

While access to treatment had improved over the years, Dr. Manjula Rao said that there was little or no awareness on breast conservation and reconstruction.

“Though breast cancer treatment is broadly covered under State-run and national schemes, care must be taken to include specialised surgeries such as sentinel lymph node biopsy, breast conservation with oncoplasty, breast reconstruction and specialised drugs such as targeted therapy and immunotherapy.” she said.

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