Lump of worry: Breast cancer is now the leading type in India. Test early, stay safe

Bangalore resident Naavneet Pusppraj Reddy, 37, had no idea why her baby had stopped feeding on her right breast even after going to five gynaecologists in six months. “The doctors kept telling me the milk might be drying out, that I should use a heating pad, that I should pump the milk out at regular intervals, and that my milk had turned to pus,” she said.

Reddy was asked to get surgery to remove an abscess, a pocket of pus. On the operation table, the doctor suspected the lump to be cancerous and took a sample for biopsy. The test was positive.

By the time the diagnosis came, Reddy’s cancer had spread and it was in stage four.

“More than 60% of breast cancer patients come to my clinic in advanced stages, this includes even well-educated, rich people in cities,” says Dr PK Julka, senior director of Delhi’s Max Institute of Cancer Care, who treated Reddy. “To give you a comparison, a hospital in Italy detects breast cancer when a tumour is 40mm. On average, we detect it when a tumour is 40 cm.”

Dr Reetu Jain, medical oncologist at Jaslok Hospital, says that even until five years ago, a stage four breast cancer patient would rarely have more than six to eight months. “Today, dependent on the patient, treatments such as anti-HER2 therapy, injectable hormone therapy give the patient four to five years.”

Doctors say that early detection affords over 95% chance of survival and a high chance that the patient won’t need a mastectomy – a surgical process in with the breast is removed to ensure the cancer is removed too.

Mumbai travel-industry executive Jyotsana Tanksale felt a stone-like lump in her left breast in 2014, when she was 37. A test confirmed that she had stage two cancer. She underwent surgery to remove the lump and over the next eight months, she had 16 sessions of chemotherapy and 31 rounds of radiation, which set her back Rs 10 lakhs.

But by the end of it, the cancer was completely gone. Tanksale’s maternal aunt had the disease too – detecting it early was her smartest move.

Is breast cancer on the rise?

Each year, an estimated 1.5 lakh new cases of breast cancer are diagnosed in India, making it the leading type of cancer among women and replacing cervical cancer. Currently, 32 in every 100,000 women get breast cancer in India.

“The cancer registries show that the incidence is definitely higher in metropolitan cities,” says Dr PK Julka, who heads Delhi’s cancer registry as the head of the department of oncology at All India Institute of Medical Sciences (AIIMS), Delhi. “This can be attributed to the lifestyle – obesity, alcohol consumption, having children later on in life. All of it increases the risk of breast cancer.”

The disease is also hitting younger and younger women. “Indian women get breast cancer ten years earlier than Western women,” says Dr Mandeep Singh Malhotra, head of the department of head, neck and breast oncoplasty at Fortis Flt Lt Rajan Dhall Hospital, Delhi. “I even get patients who are 19 or 20 years old.”

Oestrogen ups the risk

Having children before the age of 30 can reduce the risk of breast cancer. “Anything that exposes the body to excess oestrogen increases the risk of breast cancer,” says Dr Malhotra. “A woman is exposed to more progesterone when she is pregnant and lactating, reducing the exposure to oestrogen.”Shikha Singh, 33, is the mother of two. She was diagnosed with stage three

breast cancer two years ago while she was still feeding her baby girl. Unlike Reddy, she was immediately referred to an oncologist when she told her doctor that she could feel a lump in her breast and terrible pain in her left arm, making it unbearable for her to even hold the baby.

“I kept wondering why they were sending me to the oncologist. To me, it was a gynaecological issue,” said Singh. It also surprised Dr Malhotra, her doctor, as she had two young children, and was not at risk.

Early menarche (beginning of menstruation) and late menopause also increase the risk of breast cancer as both expose the woman to more oestrogen.

“Processing of fats and alcohol increases the oestrogen levels in the body too, which is why it is a risk factor,” said Dr Malhotra.

Dr Bharat Bhosle, a medical oncologist at Bombay hospital says that smoking and drinking should be completely avoided. For those who want to drink he advises, “Moderate alcohol consumption (a peg or two a week), higher fibre intake, cutting down red meat, regular exercise (brisk walking for about two hours a week) and keeping one’s weight in check can help”.

Check whether you have it

Doctors suggest all women above the age of 20, especially ones with a family history of breast cancer, should self-breast test regularly.

Retired assistant bank manager, Lidwin Pinto, 68, felt a small lump in her left breast in 2015. She sought a diagnosis immediately, which confirmed that she had stage two cancer. Her first task was to warn members of her family about a regular self-breast exam. It’s what helped her sister, ten years younger; detect a stage 1 condition in her own breasts a month later.

“The breast examination should be done using the pads of the finger and with firm pressure, done seven days before or after menstruation. Look for any lumps in the breast, whether the nipples are retracted or whether there is any discharge from either of the nipples. If there is anything suspicious, contact your doctor,” recommends Dr Malhotra.

After the age of 30, a clinical breast exam is a must, and after 40, an ultrasound or an MRI helps detection too.

It is only after the age of 45 that the doctors suggest that a woman undergo a mammogram. “Even then, the woman must consult the doctor first. Sometimes the breast is dense and the mammogram is not able to pick up anything,” said Dr Julka.

Genetic Testing

The chances of breast cancer are high in women with a family history (two or more cases of breast, ovarian, uterine or colon cancer, in two or more generations). However, only in 5 to 10% of the breast cancer cases, the gene is thought to be inherited.

What about the men? Inheriting a gene increases the risk of breast and prostate cancer in men. But, men make up only 1% of all cases, because they lack milk-producing tissue in breasts, and have lower oestrogen levels, which affect breast cell growth.

Dr Julka says that in people who have a family history of breast and ovarian cancer, it is a good idea to get tested for BRCA 1 and BRCA 2 gene mutation. Their presence increases the risk of breast cancer from 12% in general population to 85%.

The steps after that include a preventive removal of the breasts (which reduces the risk by 95%) but it doesn’t reduce the risk of ovarian cancer so women are advices to remove the ovaries too. “However, these are very drastic steps and nowadays there are drugs available that can lower the risk of breast and ovarian cancer,” says Dr Julka.

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