Fighting breast cancer: India gears up for the battle

The war on breast cancer has begun in earnest in India, with the government sitting down with stakeholders last week to draft guidelines on how best to treat it.

When Anjali Kanwar is not working at her family-owned manufacturing unit in Noida, her day is packed with zumba, circuit training, yoga and running. “I’m obsessive about working out. I train at least five days a week, for more than one hour per session,” says Kanwar.

Delhi-based Anjali Kanwar beat breast cancer a few years ago, partly because she had been getting regular screenings and caught it early. She now runs the Pinkathon every year, to promote awareness about the disease.(Photo by Ravi Choudhary/ Hindustan Times)

For two years, she has also made it a point to run the Pinkathon, in support of breast cancer survivors.

Kanwar is a survivor herself. She was diagnosed with breast cancer a few years ago, in her early 40s, a diagnosis that caught her completely off guard even though she knew she was at risk.

“Two of my mum’s sisters have breast cancer, so I had started getting yearly mammograms done the year I hit 40. The first two were fine, but the third caught early signs,” says Kanwar.

The cancerous tumour was removed in a lumpectomy that included the removal of her lymph nodes. Kanwar underwent eight cycles of chemotherapy and radiation to become cancer-free.

MISSING CARE
Kanwar beat it back because she had a more easily treatable form of breast cancer and caught it early. Locally advanced breast cancer, for instance, is an aggressive and invasive tumour that accounts for 61% of all breast cancer cases in India.

“Each year, 1.55 lakh women are newly diagnosed with locally advanced breast cancer in India. About half of these women die of it,” says Dr Sameer Kaul, a cancer surgeon at New Delhi’s Apollo Hospital. “This is in sharp contrast to the US and China, where more women are getting diagnosed with breast cancer but far fewer are dying of it.”

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These deaths are avoidable because breast cancer, if detected early, often responds well to treatment.

“Late diagnosis, the aggressiveness of the locally advanced tumours more common in India, and the absence of quality diagnostics, treatment and care jeopardises survival,” says Dr GK Rath, chair of the Rotary Cancer Institute at the All India Institute of Medical Sciences (AIIMS).

“Most women in India are still not having themselves screened because of social taboos, economic constraints, shyness about their bodies and, most importantly, lack of quality diagnostics and treatment,” says Dr Kaul. “We need strong public-private partnerships if we are to implement existing policies and standardise treatment.”

Kaul, for instance, set up the Breast Cancer Patients Benefit Foundation (BCPBF) in 2004 to provide free medicine to the impoverished and subsidise treatment for the economically backward.

“We did what we could, but we soon realised that lakhs needed help and the way forward was working with all the stakeholders to offer the best possible treatment,” he says.

THE WAY FORWARD
Last week, the Ministry of Health and Family Welfare along with India’s leading cancer surgeons, oncologists, radiologists, pharmaceutical majors, health insurance companies and cancer patients spent a day together drafting the Gulmarg Declaration, a first-of-its-kind set of consensus guidelines to treat locally advanced breast cancer.

“The Centre, public health professionals and private sector debated and drew up guidelines on how best to manage and provide affordable care to people with locally advanced breast cancer,” says Dr SH Advani, director of medical oncology and haematology at Mumbai’s Jaslok Hospital. “The consensus will ensure everyone that follows the protocols best suited to treatment for those of south Asian ethnicity.”