A third of all women who get breast cancer in India die. The reason: late diagnosis when the survival rate plummets sharply till it’s down to just 22% in stage 4 breast cancer.
Breast cancer has five stages from zero to four. While the survival rate is 100% in patients who are diagnosed at stages 0 and 1, it drops to 93% by stage 2, 72% in stage 3 and 22% in stage 4.
The key to reducing breast cancer mortality in India (survival rate here is 66% compared with over 80% globally) then, is to increase awareness about routine testing – which is also the point of observing October as Breast Cancer Awareness Month worldwide.
Here’s what you need to know, and do, to ensure early detection:
What are the early stages of breast cancer?
Stage 0, also known as carcinoma in situ (CIS), is a pre-cancerous stage when “atypical” cells just start to line the lobules or milk ducts in the breasts. Lobules are where the breasts produce milk, and the ducts carry them to the nipples.
In stage 1, the cancer is smaller than 2 cm and hasn’t spread at all. Or the tumours are tiny but have spread to two or three lymph nodes. In short, the cancer is contained and is easy to fight with radiation or surgery or a mix of both. At this stage, doctors say, there’s usually no need for chemotherapy.
The trouble is that cancer is also difficult to catch at this point unless you do regular self-examinations and routine check-ins with your doctor. Of course, as preventive medicine picks up in India, there is hope that more Indian women – armed with the right information – can avoid late diagnosis and all that comes with it.
The right way to do a self-examination
Self-examination only works if you know your body really well – the idea is to familiarise yourself with each curve, bump and mole so that if something changes, you know immediately. There are different ways to do the examination – none of them takes more than 5 minutes.
- See yourself in a mirror: Look for changes like new dimples, pimples, anything raised or sunken, any changes in shape or symmetry. Raise your arms overhead, and look again.
- Touch and feel: Use the palm or the back of your hand to feel for any bumps and lumps in the breast. Start with the underarms and work your way inward. Don’t be afraid to probe and glide your hand over the breasts. Apply a little bit of pressure when checking for lumps. Doctors recommend lying down as you do this since lying down spreads out the breast tissue.
- See your doctor if you feel a knot or bump, or if your nipples look different, or your breasts feel different or fuller than you remember. Some changes are normal while you menstruate, but over time, you’ll learn to tell the difference.
Simple tools for early detection
Mammograms, breast ultrasounds and MRIs (magnetic resonance imaging) are all used globally to check for breast cancer. Doctors recommend that women over 45 should get an examination every two years. Women with risk factors such as a family history of breast cancer may need to start sooner.
- Mammograms are simply X-rays that are customised for imaging human breasts. Some women can feel uncomfortable, or even a slight pain sensation, during a mammogram because the machine compresses each breast between plates. They do this for two reasons: one, to be able to see any calcium deposits in-between the fatty tissue, the fibres and ducts in the breast, and two, to hold the breast in place during the X-ray.
- Doctors may advise one of two types of mammograms: regular or 3D mammogram. The key difference between them is that while the regular mammography machine takes images from the front and side of the breast, the 3D mammography machine combines multiple X-rays to create a 3D image. According to one estimate, 3D mammography reduces false positives (when someone doesn’t have cancer, but the X-ray comes back with some white dots indicating calcification) by 25%. 3D mammography is also more expensive.
- Breast ultrasound uses high-frequency sound waves to detect tumours. These are more useful to detect any tumours in women with dense breasttissue (the mammograms come out almost completely white for these women).
- In women who have dense breast tissue, and those with a family history of breast cancer, an MRI is the most effective way to detect even tiny and scattered tumours. MRI uses strong magnets and can catch out anything that an ultrasound machine might have missed.
The good fight
Breast cancer is one of the leading reasons for disability-adjusted life years or DALY in women. A new study shows that things could get a lot worse before they become better for Indian women.
“Cancer mortality in India has doubled from 1990 to 2016. India’s cancer incidence is estimated at 1.15 million new patients in 2018 and is predicted to almost double as a result of demographic changes alone by 2040,” wrote Robert D. Smith and Mohandas K. Mallath, in “History of the Growing Burden of Cancer in India: From Antiquity to the 21st Century”, published in the Journal of Global Oncology in August.
As women organise walks and bike rides across India from Nainital to Trichy this month to raise awareness about breast cancer, you too can help: by paying a little more attention to your body and take preventive steps to ensure a healthier future.
This story has been written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, please read Breast Cancer: Symptoms, Causes, Treatment, Medicine.