BREAST CANCER SCENARIO IN INDIA What makes me WORRIED about the trend of breast cancer in India?

Let me explain this to you in as simple language as possible. Breast cancer is a global disease. Though the majority of underlying causes, and other features are usually uniform around the world, every region has its own uniqueness for that cancer. I will discuss in the following headings: Age shift (More young ladies affected) Rising numbers of cases of breast cancer in India Late presentation (This directly decreases long term survival of the patient Lack of awareness and Screening (Screening is the single most important factor responsible for better survival of patients in the west) Aggressive cancers in young (Generally, the younger the age below menopause, the more aggressive the cancer)

Age shift: Breast cancer now more common in 30's and 40's In India, the average age of developing a breast cancer has undergone a significant shift over last few decades. Please consider the graph below (This is only a rough representation of the data):

The horizontal line lower down represents the age groups: 20 to 30 years, 30 to 40 yrs and so on. And the vertical line represents the percentage of cases. The blue colour represents the incidence 25 years back, and maroon colour represents the situation today. 25 years back, out of every 100 breast cancer patients, 2% were in

20 to 30 years age group, 7% were in 30 to 40 and so on. 69% of the patients were above 50 years of age. Presently, 4% are in 20 to 30 yrs age group, 16% are in 30 to 40, 28% are in 40 to 50 age group. So, almost 48% patients are below 50. An increasing numbers of patients are in the 25 to 40 years of age, and this definitely is a very disturbing trend. Rising incidence of breast cancer in India Breast cancer is now the most common cancer in most cities in India, and 2nd most common in the rural areas. Please have a look at the following bar graph about percentage distribution of top ten cancers in females in Mumbai.

The complete details of cancers in various cities like Mumbai, Delhi, Bengaluru, Bhopal, Kolkata, Chennai, Ahmedabad etc. can be found on the PBCR (Population Based Cancer Registry) Website. After going through all the graphs, the point worth noting is that, breast cancer accounts for 25% to 32% of all female cancers in all these cities. This implies, practically, one fourth (or even approaching one thirds) of all female cancer cases are breast cancers. Late presentation and decreased survival Consider the image table below. This was published by ASCO in 2009, and shows the improvements in the overallfive year survival for various cancers in the United States.

The details of ASCO article cited above, can be found HERE . If you see, the over all 5 year survival for breast cancer has increased from 75% in 1970's to almost 89% presently. This means that, out of every 100 women with breast cancer in the US, 89 women are likely to survive for atleast 5 years. There are barely any similar statistics for India available, but a rough estimate from the PBCR and HBCCR reports is that, this figure is not even more than 60%. The most important reason being lack of awareness about breast cancer and screening of the same; more than 50% patients of breast cancer present in stages 3 and 4, and outcome is not as good as earlier stages, however aggressive the treatment may be. The western nations have achieved a steadily improving and good survival mainly because of screening of breast cancer. Lack of awareness of breast cancer, lack of screening Breast cancer is a non existent entity for a majority of population till a near and dear one suffers from it. Healthcare is low on priority and even in major cities, screening is also an 'alien' word for most people. So naturally, this results in most people presenting only when symptomatic, and on an average, most 'symtomatic' cancers are stage 2B and beyond (significant numbers in stages 3 and 4). So the breast cancer patients do not tend to survive for a longer time, as their western counterparts. In the West, majority of breast cancers (read more than 75%) present in stages 1 and 2, resulting in good survival; and there is an ever increasing numbers of patients presenting wih mammography detected cancer, with no symptoms. India needs to reach this achievement, and it is only with aggressive promotion of screening and awareness and proper treatment that India will achieve this; and will take atleast a few decades to reproduce similar results. Aggressive cancers in the young

Cancers in the young, tend to be more aggressive. Many of these cancers are HER2 positive and ER/PR negative, or HER2/ER/PR all three negative, and they have a worse prognosis than those who have ER/PR positive tumours. So all the more reason to catch these cancers early, since chances of long survival decrease fast with increasing stage of these tumours. Moral of the story If you have read all the above points, they are all pointing to one necessity screening for breast cancer. Since the number of cases are rising, more younger women are getting affected, most are presenting only after symptoms develop (so usually stage 2B and beyond, rarely earlier stage) and we cannot prevent this cancer, all we can do is to detect this cancer early. SCREENING is the way to go

BREAST CANCER INCIDENCE COMPARISON: INDIA - US A comparison of breast cancer in India with western nations like the US gives a good idea of the trends it is following. This comparison is obtained from Globocon Data, the latest of which is for the year 2008. You can find it HERE. The following charts and tables are followed by a discussion on them. DISCUSSION Globocon 2008 Data: Number of cases of breast cancer in India

Globocon 2008 Data: Number of cases of breast cancer in the US

From the tables above, few points are very evident as follows: In the US, breast cancer is the most common cancer amongst women and 1 in 8 women in the US have a chance of developing breast cancer in their life time. In India, the overall incidence of breast cancer is less as comapred to the US; some workers have put it around 1 in 30 or so. But if you see the actual number of cases, India is not far behind. In the year 2008, there were about 1,82,000 breast cancer cases reported in the US, whereas in India, 1,15,000 new cases were diagnosed. This implies that, though, because of India's population, the percentage of total women affected seems less, the breast cancer burden in India has almost reached about 2/3rds of that of the US and is steadily rising. In the tables, there are two columns: 'incidence' and 'mortality'. Incidence tells us the number of new cases of cancer in that year, and mortality tells us the number of deaths in that year. A ratio between the incidence and

mortality gives a good idea of how long do the patients survive on an average. For US, we have 1,82,000 new cases and about 40000 deaths (ratio 4.5:1, meaning about 1 death for 4.5 new cases detected). For India, we have 1,15,000 new cases and 53000 deaths. This maens a ratio of about 2:1, which indeed is bad (1 death for every 2 cases detected). As the treatment of a cancer evolves, as more and more early cancers are detected, the mortality becomes less and less, though the incidence may rise, leading to an change in ratio. India's ratio tells us, it has a long way to go. Since more patients turn up in later stages, they do not survive long irrespective of the best treatment they may get, and hence the mortality is fairly high. The successive review of these figures over next ten or twenty years give us an idea whether we are detecting cancer early, are our health programmes working, etc. Globocon 2008 Data: Methods of estimation in India

Globocon 2008 Data: Methods of estimation in the US

From the above two images, I wish to highlight the dismal reporting of cancers in India and the need to work on that front. Also, the estimate may be less from what is in real experience, as quite a lot of breast cancers are treated in small hospitals or nursing homes (and many of them being inadequately treated), and will never be reported. So the number of breast cancer cases in India may be actually higher than what is estimated to be. Globocon 2008 Data: Worldwide incidence of breast cancer

What do I learn from these statistics? India is experiencing an unprecedented risein the number of breast cancer cases across all sections of society, as are also other countries. There is no way we can prevent breast cancer, but we can definitely detect it early and treat adequately. Achieving this is a society will lead to better long term survival as well as a better quality of life.

India Cancer Statistics According to india cancer statistics, cancer rates in India are lower than those seen in Western countries. But are rising with increasing migration of rural population to the cities, increase in life expectancy and changes in lifestyles. But based the india cancer statistics, rates for oral and oesophageal cancers are some of the highest in the world. How to slove the problerm of cancer in india? Compared with 2011 cancer statistics, cancer statistics in india need to research deeply with these india cancer statistics. India Cancer Statistics: Reasons of Cancer in India

1.Obesity and Physical Activity According to India cancer statistics, Obesity and lack of physical activity are associated with increased risk at various cancer sites, including breast and endometrial cancer. In India, increases in the rates of obesity, central adiposity, and waist-hip ratio associated with urbanization are seen in every region and are highest among those with the highest levels of education and income. 2.Vegetarian diets According to India cancer statistics, a large percentage of Indians, particularly Hindus, practice vegetarianism and avoid meat and fish products in their diet. Vegetarian diets have been associated with decreased risk for prostate cancer.

 3.Dietary Fats and Fiber According to India cancer statistics, diets high in saturated fats have been associated with increased risk for cancer. Large epidemiological studies have identified a possible association between increased dietary fibre and a decreased risk for cancers of the colon and breast. 4.Spices and Food Additives According to India cancer statistics, among the most studied in recent years is turmeric, an ingredient in the common Indian curry and a spice that has been shown to be a potent antioxidant and anti-inflammatory agent with additional promise as a chemo-preventive agent. In a study in human blood cancer cell lines, turmeric suppressed and destroyed blood cancer cells. 5.Micronutrients According to India cancer statistics, direct and indirect relationships between micronutrients and health have been described in experimental, epidemiological and clinical trials.Vitamin deficiencies, specifically of vitamins A, C and E, may contribute to the high prevalence of oral cancers in India. India Cancer Statistics: The Type of cancer in India Oral Cancers

Based India cancer statistics, Incidence rates for oral cancer in India are among the highest in the world. Most are associated with diet, weight, and other lifestyle factors. A significant lifestyle risk factor is betel quid (paan) chewing, a practice that is highly prevalent in India. Betel quid contains a variety of ingredients such as lime, catechu, and areca nut and is often mixed with tobacco. Oesophageal Cancer

In India, the incidence of oesophageal cancer is moderately high and is associated with certain diets and lifestyles. According to India cancer statistics, oesophageal cancer is the second most common cancer among males and the fourth most common cancer among females according to combined data from cancer registries in India. Endometrial, Cervical, and Ovarian Cancers

According to India cancer statistics, cancer of the female reproductive tract has a high incidence amongst Indian women. Human papilloma virus (HPV) is the most prevalent risk factor for cervical cancer and has been associated with cancer of the ovaries and endometrium. Breast Cancer

According to India cancer statistics, in India, the incidence of breast cancer is increasing, with an estimated 80,000 new cases diagnosed annually. The incidence of breast cancer increased by approximately 50% between 1965 and 1985. Stomach Cancer

With these India cancer statistics, compared to other countries, stomach cancer incidence rates are moderate to low in India, although certain populations, such as those in the Chennai area, have very high rates. Cancer Prevention Based India Cancer Statistics

India Cancer Statistics reming people should pay more attention on their health. From these India cancer statistics, there are 7 steps to prevent cancer. 1.Avoid tobacco use As already discussed, tobacco is the major risk factor for cancer. Hence, it is important to avoid tobacco in all forms, like both active and passive smoking and chewing tobacco. 2.Eat a variety of healthy foods It is important to consume plant-based foods, rich in fruits and vegetables, reduce the intake of fat and alcohol. 3.Stay active and maintain a healthy weight Regular exercise should be an integral part of one's daily routine. 4.Protect yourself from the sun Exposure to sun is the major cause of skin cancer. It is important to avoid the sun's ultraviolet rays, especially from 10 am to 4 pm and applying adequate amounts of

sunscreen lotion with a sun-protecting factor (SPF) of at least 15, especially before venturing outdoors during these hours. 5.Get immunized Vaccination against Hepatitis B should be regularly administered, as this infection could lead to liver cancer. 6.Healthy practices Sexually transmitted diseases like human papilloma virus infection, hepatitis B and HIV can lead to an increased incidence of various cancers. It is thus important to practice safe sex by using condoms, limit the number of sexual partners, or abstain from sex and never share needles. In case of drug addiction, it is important to seek help. 7.Get screened Regular screening and self-examination for certain cancers helps in early detection of cancer and improves the prognosis. India Cancer Statistics - Cancer Treatments in India The modern approach to cancer treatment in India does not differ much from standard protocols in the USA. Treatment in the USA is more advanced in some ways and it is also more widely accepted among the population as a whole. India has access to the many different surgical operations and palliative therapies. They also have radiation clinics and treatment centers, usually located in the hospital settings. Chemotherapy treatment modalities and other drugs are also in use. There are many skilled doctors in India and many of them have trained for years in other countries to learn the latest skills. One of the biggest differences in the cancer treatment setting in India lies with the population and the ancient beliefs and traditions of their Swamis and other herbal healers. There is an ancient practice of medicine in India that is called Ayurevedic medicine and the Swamis, or holy men, are some of the more devoted participants in this form of medicine. An Ayurevedic healer has been trained in the art of using herbs and other plants to treat any ailment or disease. Many of the Indian people will use this form of medicine as opposed to any modern practices. India Cancer Statistics - Colorectal Cancer It is believed that colorectal cancers consider many different many years to develop, ordinarily starting getting a pre-cancerous polyp even although in the color or rectum. as a final result of the fact they have a tendency to think about this sort of the prolonged time to develop, there is time to detect the growths and remove them before to they develop to be troublesome. this could be why colorectal cancer is truly a really preventable disease. Symptoms of Colorectal Cancer: 1. modifications in bowel habits. this could manifest in constipation, diarrhoea,

bowel incontinence, and sensation of unfinished bowel movement. 2. producing of narrower stools than normal. 3. Presence of bloodstream in stools. consider note, however, that not all bleeding is as a final result of cancer. Other troubles which include hemorrhoids (piles), ulcers, ulcerative colitis, etc. may also create bloodstream in stools. 4. Anemia. This may be the shortage of red-colored bloodstream cells.