Multiple factors such as genetic mutations, longer life expectancy, hormonal imbalances, intake of hormones through medicines, delayed or no breast feeding, menarche and menopause among the younger population has made Indian women vulnerable to breast cancer. As the country observes and dedicates the month of October to breast cancer, a look at its incidence and prevalence not only in Telangana but also in the country indicates that the ailment has become the leading cause of cancer among Indian women.
The landmark study on disease burden of Non-Communicable Diseases (NCDs) in India by Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI) and other agencies, published recently in The Lancet journal, has clearly established that the breast cancer indeed has become a major form of cancer for Indian women.
In fact, the ICMR study said that over the last 26 years i.e. between 1990 and 2016, even the age of women, who have been diagnosed with breast cancer, has decreased. This means that women from the age of 30 years are now getting diagnosed with breast cancer, which was not the case earlier.
The cancer disease burden study of ICMR is relevant not only for all India but also to the two Telugu speaking States, because the ailment is ranked number one i.e. the leading cancer among women in both Telangana and Andhra Pradesh.
Overall, across India in 2016, the estimated incidence of breast cancer cases in India i.e. the rate of new breast cancer cases, was 1,18,000 women. In the same year, the prevalence of breast cancer cases in India was 5,26,000. Moreover, in the last 26 years, the ailment became number one among women in every Indian State, which should give a fair idea to public health experts on where to lay more focus on.
In yet another study that involved ICMR researchers, the age-adjusted rate of breast cancer was as high as 26 women and mortality or death about 12 women for 1,00,000 population. Age-adjusted rate is a technique that allows comparison of population when the age-profiles of the population are quite different. There are projections that suggest that by 2020, the number of breast cancer cases in the country can go as high as 17, 97, 900.
To frame the procedures and guidelines, founder of UBF Dr P Raghuram was also appointed member of the high-powered steering committee and Technical Advisory Group (TAG) to guide and form a breast cancer screening strategy for India.
The issue:
An organised population-based breast screening programme using mammography is the best proven way to detect cancers. And yet, it is not a viable option in India due to the enormous costs involved, huge variation in mammographic reporting and quality assurance issues.
The Indian solution:
Since 2012, UBF and health authorities have implemented South Asia’s largest breast cancer screening programme through Clinical Breast Examination (CBE). The programme was implemented in 15 districts of TS and AP and over 2 lakh underprivileged women in 4,000 villages were screened for breast cancer.
“Instead of depending on mammography, we decided to train health care workers, comprising mostly women, to clinically examine the breasts of women. This is relatively simple and inexpensive screening method and there is circumstantial evidence to show that this is a viable screening tool for a country like India,” says Dr Raghuram.
As part of the screening programme, women between the age group of 35 years and 65 years were screened for signs and breast cancer. Thanks to the CBE programme, it also imparted training to as many as 3,065 healthcare workers.
“Detecting breast cancers when they are small will undoubtedly help reduce death rate from this disease. More importantly, CBE presents an excellent opportunity for healthcare providers to educate importance of early detection of breast cancer in the community,” he said.
The CBE programme of TS and AP eventually became a part of the national guidelines for breast cancer screening programme. Currently, healthcare workers across the country are being trained to perform the examination. As a pilot project, the initiative is being implemented in five districts before being expanded to other parts of the country.
On the rise of breast cancer:
Conservatively put, we come across 7,000 to 8,000 women with breast cancer cases every year and unfortunately 60 per cent to 70 per cent of them come at an advanced state. To counter this, we need a solution that will be tailor made for Indian population. Mammography itself is very expensive and everybody can’t afford the diagnostic tool. Moreover, there is also a shortage of trained personnel who can report the mammography properly.
On importance of counselling:
Counselling is a very important component of breast cancer care because it makes patients and their relatives better informed, better prepared and more importantly, feel more in control at every stage of their treatment. Counselling should involve discussion about the diagnosis, adequate psychological and emotional support and various treatment options by the specialists in a sensitive and supportive environment. It is also the duty of the specialist to clarify questions posed in an unhurried manner and reinforce the points in simple easy to understand language.
On making counselling a part of curriculum:
Counselling is not part of the Indian medical curriculum. There are enormous lacunae in the way breast cancer is diagnosed and equally, very little time is spent by health professionals in reassuring the patients with benign breast health issues, which always tend to be far more common than breast cancer.
Are most breast lumps cancers?
By my estimates, 9 out of 10 breast lumps are not cancers. However, it is vitally important to investigate by way of triple assessment that includes clinical breast examination by a specialist, bilateral mammogram and ultrasound guided core needle biopsy in order to obtain a definitive diagnosis.
Does breast cancer affect only older women?
Although majority of breast cancers occur in women over the age of 50 in the western world, it can in fact occur at any age. It is alarming to note that majority of breast cancers in India are diagnosed at a much earlier age in India, which should worry all of us.
Visit Amri Hospital Best Cancer Hospital in Kolkata
The landmark study on disease burden of Non-Communicable Diseases (NCDs) in India by Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI) and other agencies, published recently in The Lancet journal, has clearly established that the breast cancer indeed has become a major form of cancer for Indian women.
In fact, the ICMR study said that over the last 26 years i.e. between 1990 and 2016, even the age of women, who have been diagnosed with breast cancer, has decreased. This means that women from the age of 30 years are now getting diagnosed with breast cancer, which was not the case earlier.
The cancer disease burden study of ICMR is relevant not only for all India but also to the two Telugu speaking States, because the ailment is ranked number one i.e. the leading cancer among women in both Telangana and Andhra Pradesh.
Overall, across India in 2016, the estimated incidence of breast cancer cases in India i.e. the rate of new breast cancer cases, was 1,18,000 women. In the same year, the prevalence of breast cancer cases in India was 5,26,000. Moreover, in the last 26 years, the ailment became number one among women in every Indian State, which should give a fair idea to public health experts on where to lay more focus on.
In yet another study that involved ICMR researchers, the age-adjusted rate of breast cancer was as high as 26 women and mortality or death about 12 women for 1,00,000 population. Age-adjusted rate is a technique that allows comparison of population when the age-profiles of the population are quite different. There are projections that suggest that by 2020, the number of breast cancer cases in the country can go as high as 17, 97, 900.
Telangana, Andhra set example with initiatives
The unique population-based breast cancer screening initiative launched in the two Telugu speaking States by Ushalakshmi Breast Cancer Foundation (UBF) in collaboration with State health authorities has now become a part of the national initiative on early screening of breast cancers in the country taken up by the Ministry of Health and Family Welfare.To frame the procedures and guidelines, founder of UBF Dr P Raghuram was also appointed member of the high-powered steering committee and Technical Advisory Group (TAG) to guide and form a breast cancer screening strategy for India.
The issue:
An organised population-based breast screening programme using mammography is the best proven way to detect cancers. And yet, it is not a viable option in India due to the enormous costs involved, huge variation in mammographic reporting and quality assurance issues.
The Indian solution:
Since 2012, UBF and health authorities have implemented South Asia’s largest breast cancer screening programme through Clinical Breast Examination (CBE). The programme was implemented in 15 districts of TS and AP and over 2 lakh underprivileged women in 4,000 villages were screened for breast cancer.
“Instead of depending on mammography, we decided to train health care workers, comprising mostly women, to clinically examine the breasts of women. This is relatively simple and inexpensive screening method and there is circumstantial evidence to show that this is a viable screening tool for a country like India,” says Dr Raghuram.
As part of the screening programme, women between the age group of 35 years and 65 years were screened for signs and breast cancer. Thanks to the CBE programme, it also imparted training to as many as 3,065 healthcare workers.
“Detecting breast cancers when they are small will undoubtedly help reduce death rate from this disease. More importantly, CBE presents an excellent opportunity for healthcare providers to educate importance of early detection of breast cancer in the community,” he said.
The CBE programme of TS and AP eventually became a part of the national guidelines for breast cancer screening programme. Currently, healthcare workers across the country are being trained to perform the examination. As a pilot project, the initiative is being implemented in five districts before being expanded to other parts of the country.
Need tailor made solution for Indian population, says expert
Founder and CEO of Ushalakshmi Breast Cancer Foundation (UBF), Dr P Raghuram points out that experts in public health and other stakeholder institutions in the industry should strive to come out with an Indian solution to fight the scourge of breast cancer. Interacting with Telangana Today, Dr Raghuram made it clear that the country has a real challenge on the hand.On the rise of breast cancer:
Conservatively put, we come across 7,000 to 8,000 women with breast cancer cases every year and unfortunately 60 per cent to 70 per cent of them come at an advanced state. To counter this, we need a solution that will be tailor made for Indian population. Mammography itself is very expensive and everybody can’t afford the diagnostic tool. Moreover, there is also a shortage of trained personnel who can report the mammography properly.
On importance of counselling:
Counselling is a very important component of breast cancer care because it makes patients and their relatives better informed, better prepared and more importantly, feel more in control at every stage of their treatment. Counselling should involve discussion about the diagnosis, adequate psychological and emotional support and various treatment options by the specialists in a sensitive and supportive environment. It is also the duty of the specialist to clarify questions posed in an unhurried manner and reinforce the points in simple easy to understand language.
On making counselling a part of curriculum:
Counselling is not part of the Indian medical curriculum. There are enormous lacunae in the way breast cancer is diagnosed and equally, very little time is spent by health professionals in reassuring the patients with benign breast health issues, which always tend to be far more common than breast cancer.
Are most breast lumps cancers?
By my estimates, 9 out of 10 breast lumps are not cancers. However, it is vitally important to investigate by way of triple assessment that includes clinical breast examination by a specialist, bilateral mammogram and ultrasound guided core needle biopsy in order to obtain a definitive diagnosis.
Does breast cancer affect only older women?
Although majority of breast cancers occur in women over the age of 50 in the western world, it can in fact occur at any age. It is alarming to note that majority of breast cancers in India are diagnosed at a much earlier age in India, which should worry all of us.
Visit Amri Hospital Best Cancer Hospital in Kolkata
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