Muller Journal of Medical Sciences and Research

SHORT COMMUNICATION
Year
: 2019  |  Volume : 10  |  Issue : 1  |  Page : 33--35

Breast cancer prevention and management: Evidence and possibility in India


Amit Kumar Jain1, Parvati Nandy2,  
1 Department of Medical Oncology, Artemis Hospital, Gurgaon, Haryana, India
2 Department of General Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India

Correspondence Address:
Dr. Amit Kumar Jain
Department of Medical Oncology, Artemis Hospital, Gurgaon - 122 001, Haryana
India

Abstract

In India, cancer has become a new epidemic, with breast cancer topping the list. Prevention and management of this new epidemic is restrained with limited resources and heterogeneously concentrated cancer care in India. Technology can come to help for the above, and in this short communication below, we shall discuss the prevention and management of breast cancer with special reference to the use of technology for the same in the Indian context.



How to cite this article:
Jain AK, Nandy P. Breast cancer prevention and management: Evidence and possibility in India.Muller J Med Sci Res 2019;10:33-35


How to cite this URL:
Jain AK, Nandy P. Breast cancer prevention and management: Evidence and possibility in India. Muller J Med Sci Res [serial online] 2019 [cited 2019 Jul 20 ];10:33-35
Available from: http://www.mjmsr.net/text.asp?2019/10/1/33/259249


Full Text



With 14.5 lakh new cases of cancer been diagnosed every year, a death rate of 7.36 lakh/year in India, and an increasing incidence with time, cancer has become an epidemic of the modern era.[1] In addition to the above limitation, 60%–70% of the patients are in their most productive years of life (35–64 years), with most being diagnosed at an advanced stage, leading to major impact not only on self but also on their family and the society.[2]

Breast cancer tops the list among the cancers in India, with an incidence of 1.6 lakh/year.[1] Breast cancer along with usual factors that lead to delay in diagnosis carries additional problems such as cultural and religious issues, reluctance to consult male doctors, neglect of their own health due to family obligations, and overdependence on other family members to seek medical help.

In breast cancer like any other cancer, early detection is the key to survival. Established methods of prevention are education (primary) and screening (secondary). The concept of screening is based on the natural history of the disease and is not just a test but a process which occurs in the context of much larger cancer care continuum ranging from individual patient to a structure from various levels up to national level. Mammogram is the standard, with breast self-examination, clinical breast examination, digital breast tomosynthesis, and magnetic resonance imaging being other screening tools.[3]

India being a vast country with limited resources needs a cost-effective screening tool which can be made acceptable to the masses. A reliable automated test which requires minimal skills to operate might be more appropriate than the conventional mammogram for screening in India where the majority of the population are staying in rural areas. Automated breast ultrasound (ABUS) and thermography are two such screening tests.[4],[5]

ABUS is a user-friendly, nonionizing, and a promising new screening tool. The application of ABUS in India is limited due to its high cost, and its need to be used along with mammogram as it does not show calcifications.[4]

Thermal cameras are low-cost, small, portable devices, which can enable noncontact and noninvasive screening for large populations even in nonhospital settings having a good sensitivity of 83% and a specificity of 55%. With incorporation of automatic screening algorithms with alongside the production of thermal images produced, doctors can focus on a fewer number of suspicious cases for further analysis.[5]

In a country like India where majority of cancer centers are heterogeneously concentrated and with one state (Sikkim) still not having even a radiotherapy unit and getting its first mammography unit in the state last year (2018), there arises a big question as to where should the resources be directed. This is very important as if we screen and do not have facilities to treat, there is no point to subject population for screening at all. Along with improving cancer care, we must also start phased implementation of screening program with resource-stratified guidelines as one cannot be neglected over the other in a disease which is increasing alarmingly.

As a first step toward it, the Ministry of Health and Family Welfare has recently launched an operational framework for the management of common cancers, according to which women between the ages of 30 and 65 years are screened for breast cancer by clinical breast examination once in every 5 years. It got controversial and ironical, due to which many people know about it and we need to debate it and improve it further.

Accredited social health activists are embedded in the community and are far more effective than national advertising campaigns in overcoming cultural and religious barriers. Schools and colleges are the second best medium, and in third place is the media whose help is needed to reach a large number of population. The contributions made by Mr. Amitabh Bachchan as a brand ambassador in eradicating polio in India, the contributions made by fi lm industry personnel in eradicating tuberculosis and HIV, educating men to encourage women to seek help earlier, medical fraternity acting as a role model, and the involvement of nongovernmental organizations are a few tools in creating breast cancer awareness in India.

In providing cancer care in each and every part of the country, we should keep in mind that cancer care depends on various factors such as age, sex, comorbidities, performance status, stage, pathological findings, prior treatment, facility, affordability, tolerance to therapy, and personal preferences. With ever-growing science and numerous new research papers published each day, guidelines being updated regularly, and new drugs being approved, the treating oncologist also needs to keep his/her knowledge in pace with the same, which might not be practically possible always. Thus, we need to keep ourselves updated so as to offer our patients with the best options available and after discussion with the patient and his/her attendants, a most appropriate choice thus can be made in. New tools such as IBM Watson Cancer can help in assisting clinicians make decisions. In these software's on entering in patient details, it produces a report with treatment options available with its supporting evidence and toxicities helping the oncologist exercise along his/her independent professional judgment and care decision. Although many of the leading oncology hospitals are not convinced of its benefits and with many feeling it to be more of a hype than reality, these software can be really handy, especially for oncologists practicing in tier two and tier three cities who may travel regularly for continuing medical education, to stay updated.[6]

In conclusion, it can be said that innovations in medicine are like a “leap of faith,” which have always been developed to help doctors deliver better-improving health care and safe lives. In today's era where breast cancer screening, early detection, and optimal management is a very important issue, innovations which have come in this field ought to be delivered to the Indian public as quickly and smoothly so that our mothers and sisters stay healthy, in addition to being safe and independent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1International Agency for Research on Cancer. India. Available from: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf. [Last accessed on 2018 Dec 20].
2Consolidated Report of Hospital Based Cancer Registries: 2012-2014. Bengaluru: NCDIR-NCRP (ICMR); 2016. Available from: http://ncdirindia.org/NCRP/ALL_NCRP_REPORTS/HBCR_REPORT_2012_2014/index.htm. [Last accessed on 2018 Dec 03].
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