Breast cancer, prostate cancer or any cancer for that matter can wreak havoc in people’s lives – be it the patient themselves or their family. According to Dr Sumeet Shah, a leading oncologist

, prevention and early detection are absolutely paramount when it comes to fighting the disease successfully.

So, in order to help you understand the gravity of the situation and why you need to focus on early detection of the disease, we spoke to Dr Sumeet Shah. Here are excerpts from his interview.  

What is the gravity of the situation, as regards to breast cancer, for India?

According to the Globocan 2012 data (Globocan is an arm of the World Health Organization), in the year 2012, an estimated 70,218 women died of breast cancer in India. The actual number could be lesser or more, as this number is an estimate (based on certain calculations). This number is the highest in the world, for that year. The second in line is China, with some 48,000 deaths (estimated data) and third is the US, with around 44,000 deaths (recorded data). You can clearly see a huge gap in deaths between India and other countries. 

Though the number of women being diagnosed with breast cancer is much more in other countries, the actual number of deaths from this illness is the highest in India. If we see the deaths, as a proportion of the population of India, it is lower than other countries. But that does not matter. What matters is the actual number of women dying from this illness, in India. 70,000 is a number that cannot be ignored! Each and every life is precious, and we have to act fast to get this number down. Also, for more than the last 50 years, cervical cancer had been the most common cancer in India. But now, breast cancer has overtaken it and is now the most common cancer in India, way ahead of cervical cancer, and is rising very rapidly.

Why are so many women dying from this illness?

One of the main causes is that they report late to the doctor. When I ask my patients how long back they noticed that lump in the breast, the common answer I get is ‘two or three months’. Sometimes, even six months or a year! A few months are enough to change the stage of a cancer. For example, if a lady reports to an oncologist, immediately, within a few days of feeling a ‘painless lump’ in the breast, the chance of it being in the lower stage is higher, and she might easily survive for more than 10 years, after correct treatment. But if she waits for a few months, taking alternate therapy, the ‘lump’ will grow in size; then finally she will visit the doctor, by which time, the cancer would have advanced, and even after treatment, her chances of surviving more than 5 years may be very less. So you see, waiting for a few months, after noticing the ‘painless lump’ in the breast (which turns out to be a cancer), can reduce the life by 5 years. This is just a representative example.  

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So what should we do?

‘Awareness’ is the key here. The reason why so many women report late to doctors is that they are not ‘aware’ of the symptoms of breast cancer. Most women do not know that the most common symptom of a breast cancer is a ‘hard painless knot or a lump’ in the breast. If they knew, most of them would surely have reported to their doctors the moment they felt it and would not have waited for months.

It is essential that women are aware of all the common symptoms of breast cancer. A woman should know about self-examination and about regular clinical checkups.

During our first year of training as a doctor, we are taught a statement ‘What the mind does not know, the eyes cannot see. Or in this case, the hands cannot feel!’ This statement is so apt here. If a lady is taught how to feel and look for a lump, she can easily detect it even when the lump is around 2 cm (which is a fairly small size and an early stage cancer). If she does not have in mind what to look for, she is likely to miss it, even if it fairly big.

When should you start worrying about breast cancer? Doesn’t it affect only older women?

NO! This is the most common misconception that women have about breast cancer. Most feel, it is an illness of the old. It is not so! No age is immune to breast cancer! The fact is, more than half the women suffering from breast cancer in India, are in the 25 to 50 years age group. In fact, we are now seeing a significant number in the 30 to 40 age group. Hence, the guidelines (framed by NCCN) for early detection of breast cancer, advise being alert from the age of 25. You can read in detail, all the guidelines at http://www.breastcancerindia.net/bc/screening/guidelines.htm

Are there any blood tests to detect breast cancer?

No. There are no blood tests that can detect breast cancer, or for that matter, any cancer. And the standard guidelines have strictly mentioned against doing such blood tests and tumour markers, for ‘detection’ of cancer. Except PSA (for prostate cancer), no tumour marker blood test is approved for use in detection of cancer. In spite of this, I can see so many labs everywhere as well as corporate hospitals, advertising cancer detection packages and doing all possible tumour markers in blood tests. It is very unfortunate and is only to be condemned. When we find that some individuals are at a higher risk of developing any particular cancer, that is the only time certain tests (in combination) are recommended, and strictly under the supervision of an oncologist. 

For breast cancer screening, mammography can be done only after 40 years of age, and preferably under a medical guidance. Just don’t go and do a mammogram on your own. There are pros and cons of the same.

To sum up, for early detection of breast cancer, all you need is ‘awareness’. Nothing more. The single important person in the early detection is you yourself. Be alert. No laboratory test or radiological investigation can replace an aware woman.

You should ideally visit your doctor once a year (after crossing 35 years of age) and get a history and evaluation done. Apart from cancer, get yourself evaluated for hypertension, diabetes, any symptoms of heart disease, thyroid etc. A clinical breast examination and a PAP smear are the only two things recommended for cancer detection. Other investigations should be done, only if some abnormal finding turns up. After 40 years, a yearly mammography may be done if advised by your doctor.

Will early detection of breast cancer reduce the number of women dying from breast cancer?

Yes, it surely will! The awareness programs and guidelines in the US date back to late 70s and 80s. After working aggressively on educating women about breast cancer, planning screening programs and other related things, the death rate from breast cancer in the US started declining in early 2000 (in spite of an increase in the number of women suffering from breast cancer)! It took almost 30 to 40 years to achieve that. So, presently, with an estimated 70,000 deaths in a year from breast cancer, India has a very long way to go. We will start seeing a fall only after about 3o 50 years from now! And that too, if we start spreading awareness today.