Every year more than 160,000 new cases are being diagnosed. According to GLOBOCAN 2012," India is facing challenging situation due to 11.54% increases in incidence and 13.82% increase in mortality due to breast cancer, i.e. not only the number of women affected by Breast cancer has risen, but no of women dying due to breast cancer have also raised more. In Urban areas, 1 in 22 women is likely to be affected by breast cancer.
An important fact is that Breast Cancer is a decade and a half younger in India as compared to the west. The peak age at which a maximum number of women in India are getting affected by Breast cancer is between 45 to 50 years which is a decade younger than western countries. It is a pity that women are now getting entangled in this rising menace of Breast Cancer when they are in their most productive phase of the life cycle.
Detected At Advanced Stages
More than half of the cases are detected at an advanced stage, i.e. Stage III and above, i.e. majority of women in India when they are diagnosed with Breast cancer, cancer has already progressed to the armpit, or it has involved the Breast skin or nipple. Out of the two women diagnosed with Breast cancer, only one survives due to the advanced stage of disease presentation. In western population, more than 80 % women are being detected when the disease is limited to breast, not spread to the armpit or any other site in the body and having a small volume, i.e. < 2cm tumour size, i.e. Stage I/ II with a survival rate of more than 80%.
Why the rise in Breast Cancer?
Breast Cancer is generally caused by the following :
1# Lifestyle issues: A female's body is governed by the interplay of estrogen and progesterone hormones. Estrogen promotes cell growth, whereas Progesterone causes cell maturation and stabilization. In a woman's life, if estrogen exposure is more, it means more cell growth and cell multiplication, therefore more chances of mutation(changes which cause cancer) to occur, leading to Breast cancer. Such situations arise with :
- Early Puberty
- Late or no Pregnancy
- Limited or No Breast Feeding
- Hormonal exposure in the form of Hormonal replacement therapy or Hormones in any form; assisted reproduction methods
- Even increased stress and alcohol causes estrogen to rise in a woman's body
- Obesity and lack of exercise also cause increased levels of estrogen
2# Environmental Factors: Increased exposure to pollutants also contribute to growing Breast cancer in India.
- The carbon in the air pollution or when a woman smokes bind to the estrogen receptors in the body and breast. Today air pollution is on the rise, and a lot of women have started to smoke.
- The Pesticides and chemicals in our food and water also bind to these estrogen receptors and contribute to a rise in Breast Cancer.
3# Hereditary factors: There are specific genes like BRCA 1 and BRCA 2, which cause mainly Breast and Ovarian cancers run in the family. It means that if a woman harbour's BRCA gene, there is 80% chance that she will get Breast cancer in her lifetime and 40 % chance that she will get Ovarian cancer. There is a 50 % probability that the gene will be transferred to the next generation and can cause cancer. The exact prevalence of these genes in the Indian population is not yet known. In the US, around 15% of Breast cancer is Hereditary. A lot more needs to be written about the Hereditary component of Breast Cancer, which shall be followed in subsequent articles.
Breast Cancer in India is rising at an alarming pace. We need to adjust our lifestyle, lead a healthy and stress-free life; limit or control our habits. Timely Pregnancy in today's times shall be 35 yrs or less. It reduces the risk of Breast cancer. If someone feels that there is a history of cancer, mainly breast and/or ovarian should consult medical personnel.
With inputs from Dr Mandeep S Malhotra, HOD- Head, Neck & Breast Oncoplasty at Fortis Flt. Lt. Rajan Dhall Hospital
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