The incidence of breast cancer is on the rise and what is alarming is that it has now succeeded cervical cancer as the number one cancer on our country. In the last 10 years, the incidence has gone up from 1 lac new cases to 1.8 lac new cases a year. The urban incidence is much higher than the rural incidence, indicating there is something wrong with our environment, the food we eat, the air we breathe and the water we drink. Our lifestyle and the stress of our fast moving lives is not helping the cause much either. Our best chance against cancer is early detection. Early detection will happen only if each lady is breast aware and learns the right method of performing a Breast Self Examination ( BSE) starting at the age of 20 and doing it every month, a week after periods or on a fixed day if menopause has been attained. The West may condemn the use of BSE as a screening tool but in a country like ours where there is no Screening policy and access to Mammogram machines is poor as also a huge dearth of trained professional to read mammograms, the relevance of BSE is not lost on us. Our challenge is that we still see about 60% of breast cancers in advanced cases and familiarity with the breast will help us catch the disease early.
An annual visit to the Clinician for a thorough examination of breasts after the age of 40 has shown to be of benefit in diagnosing cancer early. In a recent publication by the Tata Memorial Hospital, comparing two groups of women, one who underwent clinical examination by trained personnel once a year and two, those who did not, it was found that in the group undergoing annual clinical examination, early detection of cancer reduced the risk of dying from breast cancer by 30% in those women over the age of 50 years, compared to the other group.
What Should You Be Aware Of?
Never ignore a new lump in the breast at any age, especially if it is painless. You need to see a breast surgeon at the earliest, get yourself examined, imaged with a mammogram (over 40 years) or an ultrasound breast (under 40 years) and have an ultrasound guided needle biopsy done. All lumps in the breast are not cancer but this systematic approach of TRIPLE ASSESSMENT will definitely help arrive at a diagnosis and allay your fears.
The other symptoms that should raise an alarm are dimpling of skin, nipple getting pulled in ( of recent origin), spontaneous nipple discharge which is watery or bloody, changes in the skin of the breast ( orange peel appearance), recent and significant change in the size of the breasts etc.
Why Should Breast Cancer Be Detected Early?
Early diagnosis is the key to better outcomes. Small tumors would mean lesser treatment and better outcomes. Treatment of breast cancer is multimodality. Surgical treatment is the mainstay of treatment in early breast cancer. It is possible to save the breast in suitable cases. Surgery is followed by chemotherapy but if the biology of disease is favorable, one may escape chemotherapy. This happens in about 10-20% of cases. Radiotherapy is required whenever the breasts are conserved and also in advanced cases of breast cancer. With intensive research in the field of breast cancer, newer targeted and hormonal treatments are available, to allow for personalized treatment.
How Does One Access Treatment?
Once a diagnosis of breast cancer is made, one is advised to go ahead with the multimodality treatment of the disease ( a combination of surgery, chemotherapy, radiotherapy, targeted treatment, hormonal treatment, immunotherapy etc) basis the stage and biology of disease. It sounds doable in places where the facilities are available in terms of the manpower and technology. The expense associated with treatment can make the entire exercise prohibitive. The theme of this year’s World Cancer Day was very apt- ‘Close The Gap’. While Tier 1 cities have adequate facilities and Tier 2 cities are picking up, the same cannot be said about the entire country. Skilling younger colleagues and working on affordable solutions innovations will definitely help to close the gap.
How Is The Indian Association of Surgical Oncology (IASO) Engaged In ‘Closing The Gap’?
IASO, as the largest Surgical Oncology association, is leaving no stone unturned to reach out to young, aspiring surgeons with interest in Surgical Oncology and engage with them to work towards creating a workforce, well equipped to offer uniform care across the board. There are various regional CMEs being held other than the Annual NATCON and the IASO MIDCON every year. The focus is also on Subspecialities, so that one can upskill himself or herself in his or her area of interest earlier than later. With several national and international fellowships being awarded to meritorious young oncologists basis the original research they submit to the Annual conference, every year, the opportunities are many. Becoming a member of the IASO opens up various possibilities of honing one’s skills and delivering the same at their workplace. The IASO MIDCON being held in Shillong, is a testimony of the commitment that IASO has, in creating a level playing field across the country.
The Fight Against Cancer is Everyone’s Collective Responsibility!!
(The writer is Sr. Director,Oncoplastic Breast Surgeon, Max Hospital, Delhi. This paper is being presented at the MIDCON IASO 2022-Midterm Conference of the Indian Association of Surgical Oncology scheduled for March 25-27, 2022 at the State Convention Centre, Shillong)