Better awareness about breast cancer and its early detection can greatly reduce the need for more advanced forms of treatment like chemotherapy. In a largest-of-its-kind study in Mumbai, involving over 22,500 women, experts found that screening programmes resulted in early diagnoses and timely surgeries, doing away with the need for chemotherapy, which is more often used in severe stages of cancer.
The study, ‘Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai,’ done between June 2013 and June 2016) by International Agency for Research in Cancer, France in association with Bhabha Atomic Research Center Hospital (BARCH), Mumbai, emphasised that better awareness about the disease will lead to early detection.
In lower-middle income countries like India, there are no organised breast cancer screening programs run by central or state governments. While tests like mammography (an x-ray of breasts, used to diagnose tumors) are only used for diagnosis in public sector, women are largely dependent on private hospitals for screening. “The ongoing study is a model to show how a systematic breast cancer awareness clinical down-staging program, access to early diagnostic methods and increase in awareness can result in better cancer control,” said Dr Anita Gadgil, Department of Surgery, BARCH.
Participants of the study were employees of BARCH between the age group of 30-69 years. The researchers mailed awareness brochures with information about breast anatomy, physiological changes and early symptoms and signs of breast cancer along with high cure rates and improved cosmetic surgeries following early detection and adequate treatment. About 88000 brochures were sent quarterly in a year for four years and five breast cancer clinics were established in primary health care centers where the doctors and nurses were trained in clinical breast examinations (CBE), a physical examination of the breast for early detection of tumours and other breast problems. Women with suspicious CBE findings were sent to secondary care health setting of BARCH.
When the researchers compared the interim results of the study with a ‘pre-intervention,’ period of June 2005-May 2013, they found out that cases were being diagnosed earlier than usual and there was a reduction in the fatality rate.
Researchers also found out that the proportion of women with early tumours and axillary lymph node negative cancers increased from 74% to 81% and 46% to 53% respectively, between the two periods. While the proportion of patients receiving breast conserving surgery increased from 39% to 51%, the proportion receiving chemotherapy decreased from 84% to 56%. Dr Vinay Deshmane, medical director of Mumbai Cancer Registry, maintained by Indian Cancer Society said that while early detection doesn’t decide whether an individual will need chemotherapy or not but it certainly helps better cancer management. “Chemotherapy is given on the basis of the biomarkers and aggressiveness of the tumour. Having said that, the earlier it is detected, better placed is the treating oncologist to downstage the tumor,” said Dr Deshmane.
Dr Gadgil added that while the study is still ongoing to find out more about the early detection methods and the results, need of the hour is for the government to step in and develop the network of primary health care settings as early cancer detection centers. “Organisations like TMH have been working on different settings of the city for screening programs and creating awareness about breast cancer, but government can play a pivot role in spreading the message and resources,” said Dr Gadgil.
Experts from Mumbai added that cancer awareness program can achieve impressive results if a network of doctors, NGOs and residents works in tandem with the government under the umbrella of a singular policy. “Cost reduction of the drugs is more important looking at the socio-economic status of the population. While we are talking about awareness, there is also a need to create a system where the patients are given basic facilities like shelter and food while coming for treatment at tertiary care centres,” said Dr Ganapathi Bhat, Medical Oncologist and stem cell transplant physician, Jaslok Hospital.