Breast cancer is striking Indian women nearly a decade earlier: Which screening tests do women need and when?

While breast cancer was historically viewed as a condition primarily affecting older women, clinical studies right here in Thiruvananthapuram, including research from the Regional Cancer Centre (RCC), showed that Indian women are diagnosed nearly a decade earlier than women in Western nations.

Breast cancer is the most commonly diagnosed female cancer in India, accounting for 26.6 to 27 per cent. The average age for a breast cancer diagnosis is 51 to 53 years in India, which is roughly a decade younger than the average age in Western countries. Breast cancer accounts for 31 to 34 per cent of all female cancer patients in Kerala. Approximately 30 to 35 per cent of breast cancer patients in Kerala are diagnosed in individuals under the age of 50, showing a notable proportion of premenopausal cases. Cases diagnosed at or below 35 years old and breast cancers in lactating women are uncommon, but present with more aggressive clinical features.

The cause of breast cancer is multifactorial. Sedentary routine and weight gain are associated with higher incidence. Early onset of menstrual cycles (menarche) < 12 years, late menopause (after 55 years), delayed first childbirth after the age of 30 years, nulliparous women (women without children), alcohol consumption, family history, prior radiation treatment to chest and hormone replacement therapy increase the risk of developing breast cancer. Inherited gene mutations account for approximately 5 to 10 per cent of all breast cancer cases.

Every woman should be aware of her own breast appearance and consistency. She should know how to do breast self-examination, which is usually done 5 to 7 days after the menstrual cycle in premenopausal women. In postmenopausal women, breast self-examination is usually done on the same date every month.

Breast self-examination is usually done in a standing or lying down position. The right breast has to be examined with the woman's left hand and vice versa. It is usually done with the flat of the fingers. It should not be done with the fingertips or palm because the fingertips are too sensitive and the palm is relatively insensitive. The entire breast tissue has to be examined with the flat of the fingers, starting below the collarbone. Remember to examine the armpit, because the tail of the breast tissue reaches the armpit. If you have any doubt about the appearance or consistency of the breast, please consult a physician.

What to look for in a breast self-examination?

Look for lumps in the breast or armpits. Check the breast symmetry and be aware of any skin changes on the breast such as redness, dimpling, puckering or skin thickening (orange peel texture). Look out for nipple position and retraction.  Meet your physician if there is spontaneous nipple discharge. Usually, breast pain occurs in advanced stages. So many early breast cancers may be relatively painless. We see arm swelling only in advanced cases.

Mandatory tests for breast cancer:

X-Ray Mammogram is the screening test for breast cancer. Screening tests are done on apparently healthy women without any complaints.  X-Ray Mammogram is not advised in younger women because of dense breast tissue, which lowers it's sensitivity. For women above the age of 40 years, Mammogram is recommended once every 2 years, and for women above the age of 50 years, annual mammogram is advised.

Women are skeptical about doing mammograms because of pain and radiation exposure. The typical mean glandular radiation dose for a standard screening mammogram (four total views) is only 0.3 to 0.5 cGy, which is very low. Mammography has been shown to reduce the breast cancer death rate by 20 to 40 per cent. The benefits, like early detection, higher cure rates, longer survival, and breast conservation in early stages, outweigh the negligible side effects like pain while undergoing a mammogram, which is bearable.

MR mammography in breast screening is recommended only in women with a strong family history and dense breasts. In women with a strong family history, genetic screening identifies inherited gene mutations, such as BRCA1 and BRCA2, that raise a person's lifetime risk of developing the disease. It is just a blood test, but it has to be done after counselling. Women with a BRCA1 or BRCA2 gene mutation have a 55 to 85 per cent lifetime risk of developing breast cancer, which requires X-ray mammograms and MRI mammograms every 6 months.

Lifestyle modifications, exercise and breastfeeding reduce the risk of developing breast cancer. Breast cancer has high cure rates when diagnosed in early stages.

Learning about breast cancer is not about fear. It is about empowerment. If you or a loved one notice a change, do not hesitate or delay out of fear or stigma; seek treatment at the earliest. Stay informed, seek early evaluation, and support one another. Through this, we can save lives and ensure a healthy future for our community. 

(The author is a consultant, Department of Radiation Oncology, KIMSHEALTH, Thiruvananthapuram)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.