Of the many cancers affecting women in India, Breast Cancer(BC) is the most prominent disease with widespread impact in terms of its rates of incidence and mortality. Recent trends indicate that Breast Cancer occurrence is alarmingly on the rise in India with new cases detected across various age, socio-economic and urban-rural strata.
Differences in Breast Cancer Scenario in India and West
Parameter |
India |
USA |
Age Standardized Rate |
30-33 ( urban) |
46 |
Incidence |
Approx.145,000 |
Approx. 270,000 |
Mortality |
Approx. 75,000 |
Approx. 70,000 |
Incidence-to-Mortality |
2:1 |
4:1 |
Stage of Detection |
Late/Advanced, Stage III or IV |
Early, Stage I or II |
Age at First Diagnosis |
42-44 years |
60-62 years |
Lifetime Risk |
1 in 22 women |
1 in 8 women |
Physiological Status |
Pre-menopausal |
Post-menopausal |
Mastectomy Rate |
Very High, almost 70% |
Low, almost 30% |
Genetic Linkage |
Largely unknown |
Well-established |
Clinical Sub-Classification |
Largely unknown |
Well-established |
Government Involvement |
Not on governmental agenda |
National BC Screening Programs |
The disease has gained a predominantly urban profile with many new cases seen in middle-aged working class women with urban lifestyles. More than 20% of all cancer-related deaths are attributed to BC. Largest estimated numbers of BC deaths worldwide are from India which is attributed to the late presentation of the disease which decreases long term survival of the patient. BC in India is now mainly characterized as an early onset disease in urban women with short disease-free interval that exhibits high mortality.
References
Goss PE et.al. Challenges to effective cancer control in China, India, and Russia. Lancet Oncology 2014 Apr; 15(5):489-538
Rajaraman P .et.al. Recommendations for screening and early detection of common cancers in India. Lancet Oncol. 2015Jul; 16(7):e352-61
Need for Translational Research in Breast Cancer
Most of the research data that has influenced the guiding principles of modern-day BC management has been generated in the western countries. The Indian BC scenario differs from that in the west with regards to the socio-economical, psychological and biological difference in the two populations (Table 2). Therefore, it is incorrect to simply extrapolate the research findings and BC management guidelines from western societies and apply to the Indian context. The lack of similar research in Indian women signifies a knowledge gap which can be only bridged by undertaking India-specific research programs in BC focused on the local context and population.
With this background, PCCM has created a Center for Translational Breast Cancer Research aimed at improving various aspects of BC management in India by undertaking research projects attuned to the Indian context. Various research projects are underway with themes in epidemiology, public health interventions, BC surgery, medical management, genetics, early detection modalities in the laboratory and community. In addition, we are exploring how to integrate India’s rich traditional knowledge base namely Ayurveda into mainstream BC management protocols. It is expected that the outcomes from the ongoing and future research projects will positively affect the status-quo on protocols and policies related to BC diagnosis and management in Indian women.