Twenty-nine-year-old Deepika Jauhari was shocked when the small cyst detected in her right breast turned out to be cancerous. This was after three doctors had dismissed it as just an infection. By the time the diagnosis was confirmed in April, the cancer had spread to Jauhari’s lymph nodes and bones. She underwent 10 cycles of chemotherapy at the Medanta Medicity Hospital in Gurgaon, near Delhi.
The latest PET-CT (Positron Emission Tomography-Computed Tomography) scan, in August, shows there is no residual disease, and she is getting regular monthly check-ups and tests.
October is the awareness month for breast cancer, the world’s most common cancer in women. According to the World Health Organization, cases diagnosed in 2012 showed that 25% of all cancers in women are breast cancer. What is scarier is that more and more younger women are being diagnosed with it, and are succumbing to it. The American Cancer Society says the risk for women in their 20s is one in 1,732. Kenneth E. Thorpe, chair of the Partnership to Fight Chronic Disease, a US-based organization of patients, community organizations, business and labour groups and health policy experts, which has an office in Gurgaon, says India-specific statistics suggest a similar trend. “The National Cancer Registry Programme lists that 20% of all breast cancer cases in India occur among women below the age of 40. And according to the National Cancer Registry Programme, almost 48% breast cancer patients are below 50 and the percentage of cancer patients in the 30s has gone up from 16 to 28 in the past 25 years,” he says. Gagan Saini, senior consultant (radiation oncology) at the Fortis Hospital in Noida, near Delhi, agrees: “We are seeing younger women in the OPD these days.”
Siddharth Kumar Sahai, senior consultant, medical and haemato-oncology at Paras Hospitals in Gurgaon, says research as well as a observation have shown that younger women tend to suffer from breast cancers that are fast-growing and more aggressive.
Misdiagnosis is a big problem, and one myth that needs to be busted is that breast cancer is likely to be genetic, says Dr Thorpe. “About 85% of breast cancers occur in women who have no family history of breast cancer,” adds Dr Thorpe. Sedentary lifestyles, unhealthy dietary habits, late pregnancy and genetic mutation, all play a role in the increasing burden of the disease, he says further. “Higher risk is also associated with high body mass index and excessive alcohol intake,” adds Dr Saini. A study published last year in the British Medical Journal shows that even one alcoholic drink a day increases a woman’s risk of breast cancer by 13%, compared with women who do not drink at all. A meta-analysis, published in 2013 in the Journal Of The National Cancer Institute, found that smokers had a 12% higher risk of breast cancer than women who never smoked.
“It is recommended that women between 25-40 years of age undergo a clinical breast examination at least every one-three years with a monthly self-breast examination. The self-breast examination is a simple technique that can be learnt after a simple Internet search or from a doctor,” says Dr Saini. “Screening mammograms are not recommended for women younger than 40 who are at average risk of breast cancer—the lower risk does not justify the radiation exposure. But women who are at a higher risk of breast cancer, such as those with a family history of breast and ovarian cancer, are advised a BRCA1 or BRCA2 gene mutation test. If it comes out positive, more intensive screening, with yearly examination, mammography at an earlier age and breast MRI, may be recommended,” he adds.
In the case of Jauhari, however, the gene mutation tests were negative and it may be difficult to pin down the cause. So the lesson is not to ignore any nagging doubt or abnormality, even if it is something as small as a cyst as in Jauhari’s case, and do self-examination regularly. “Once diagnosed, the patient undergoes a biopsy or needle test, and/or whole body assessment with PET-CT scan. The patient may receive all or a few of the following: surgical treatment, radiation therapy, chemotherapy and hormonal therapy,” says Dr Sahai.
“Actually, the treatment depends on the state and biology of the disease. There are multiple kinds of breast cancers, invasive, non-invasive, etc., and everyone’s cancer is different, requiring different kind of treatment. Surgery advised, too, could be a mastectomy or a lumpectomy (removal of the abnormal tissue from the breast), again varying from case to case,” he adds.
Dr Saini says the Western world, with its advanced diagnostics and therapeutics, has achieved a survival rate of over 80% for patients owing to mainly early detection and treatment. “Unfortunately, we languish far behind due to delayed diagnosis and treatment because of economic reasons and social issues. Things are changing, albeit slowly,” he adds.
The bigger fight, however, is in the mind. “A support group is important as patients tend to get depressed during the treatment,” says Dr Sahai. Jauhari too was shattered: “I was 24x7 fatigued and depressed till I decided to get hold of myself to see this difficult time through and make myself well again. I diligently did meditation every day; it helped me immensely,” says Jauhari. She even decided to shave off her hair completely because she was tired of her hair falling in thick bunches all the time—it was summer, so it was even more irritating.
“Questions like ‘why me’, ‘how me’ plague the women who get it when they are young more. But in my clinical practice, I have seen that women face the fact that they have cancer far better than men; they are stronger that way. In fact, none of my patients stopped working or quit their jobs during their treatment,” says Dr Saini. “Also, I do suggest counselling to all my patients, and most take it up too, as talking it out with a professional helps them keep their sanity and strength together. Most affected are the women who have to undergo breast removal surgery. A good counsellor can really help in building the self-image,” he adds.
The important thing is to spread awareness and break the myths surrounding breast cancer, and empower women to demand timely detection and proper treatment.