TRENDS OF BREAST CANCER IN INDIA
SOURCE OF OFFCIAL INDIAN DATA
The data that has been represented on this site, has been referenced from the following official Indian registries, which are subsets of the National Cancer Registry Programme:
In the menu below, at the bottom of the page, you can click the individual cities, to know the cancer statistics related to those cities, or you could click the link for a global comparison. For each city, the following points have been discussed, to highlight the problem of breast cancer in India:
Incidence of breast cancer in that city. Incidence means, the numbers of cases reported in a particular period, usually a year.
Age distribution. This tells us the common age groups of breast cancer
Trends over last few decades. This will show how the numbers are rising
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:
Increasing incidence of BC in younger age groups
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: Breast Awareness (Being aware about symptoms of BC, looking out for them regularly, and reporting them on time to a doctor) is the single most important factor responsible for better survival of patients in the west
Aggressive cancers in young: Generally, many cancers in the younger age group tend to be aggressive
Increasing incidence of BC in younger age groups (30's and 40's)
In India, we are now witnessing more and more numbers of patients being diagnosed with breast cancer to be in the younger age groups (in their thirties and forties). Please consider the adjoining graph (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.
Of course, one particular reason for higher numbers of younger patients is our population pyramid, which is broad at the base and middle and narrow at top, which means that we have a huge population in the younger age group and much lesser in older age group.
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 adjoining image. This was published by ASCO (American Society of Clinical Oncology) in 2009, and shows the improvements in the overall five 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 (Most, but not all). 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 - 'Breast Awareness'. 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. BREAST AWARENESS is the way to go.