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HEALTHWATCH

Create awareness, not phobia

Dr. UMA KRISHNASWAMY

October was Breast Cancer Awareness Month. This implies not just being aware of the problem but also of the dimensions of care available.

Photo: AFP

Advertising for Breast Cancer Awareness: Sometimes the hype does more harm than good.

THERE are more than one million new cases of breast cancer occurring annually around the world with the incidence rising steadily. An average of 80,000 women are diagnosed with breast cancer and 40,000 die of the disease every year in India. These figures may be an under estimation as most cancer registries in our country cover a population of approximately one to five million only, whereas the female population is close to half a billion.

Patterns

There are certain patterns to the incidence of the disease. The incidence of breast cancer is higher in the urban areas (metropolitan cities) than in rural areas, with Delhi having the highest incidence, followed by Mumbai, Chennai, Bangalore and Kolkata. Breast cancer occurs at a younger age in India as compared to developed countries. For instance, in Chennai, the maximum number of cases occurs between 45 and 49 years. The reasons for the rising incidence of breast cancer in India are speculative and closely linked to urbanisation and erosion of traditional life styles.

While all this sounds alarming, the figures must be seen in true perspective. Out of more than 4,50,000 Indian women of all ages affected by a new cancer annually, not more than 18 per cent are affected by breast cancer. (Globocan 2002, IARC). In the general paranoia about breast cancer, this comforting fact is often forgotten. Bizarre "western" statistics are uncritically parroted both in the visual and print media, creating not breast cancer awareness but breast cancer phobia.

As elsewhere in the world, the Indian woman is affected far more commonly by benign breast problems than cancer by a factor of 10 or more. It is important for women to remember this and feel reassured when and if they discover a lump in the breast. It is more likely to be benign than malignant.

Rather than succumb to panic, fanned by well-meaning family, friends and even doctors, a woman with a newly discovered lump in the breast should approach the problem in a clear headed and systematic manner. The first step would be for the woman to approach a surgeon, preferably referred by her family doctor. To rush to a "specialist" is often the first and worst mistake the woman and her family make. It is equally self-defeating to go "doctor shopping".

Specialist

Today the discriminating woman is no longer content to approach any surgeon or oncologist but opts for a breast specialist (usually a surgeon), who specialises in the treatment of breast diseases. On approaching a breast surgeon, the patient will be thoroughly examined after a detailed history is sought and subjected to an imaging modality for the breast. This is a mammogram in the instance of the woman being over 35-40 years, as these tests have limited value in younger women. In the latter instance, an ultrasound scan of the breast is substituted. This is followed in the same sitting by a needle biopsy of various levels of sophistication: a fine needle aspiration biopsy to study the cells, or a core needle biopsy or a mammotome biopsy to study a sliver of tissue. Obviously, the latter is more reliable and more informative than the former. This triple assessment is about 99 per cent accurate when all three modalities concur. The accuracy of the individual tests if taken alone is too low to be reliable.

A common error made by doctors, often urged by the anxious patient, is to bypass these steps and go straight for a surgical biopsy, falsely justified on the grounds of economy and time saving. This is poor practice indeed, leading to unnecessary surgery and subtle but serious repercussions in the long run.

No one solution

In today's world, the treatment of breast lumps — both benign and cancer — has become highly sophisticated and individualised, so as to give the patient the maximum benefit. The medical profession can no longer offer outdated one-size-fits-all solutions to women with breast problems. A step-by-step logical progression in the evaluation of a lump must be adhered to, not merely to evaluate the nature of the breast lump, but also decide on the best method of treatment and more importantly not jeopardise the potential for future treatment. It is only after a triple assessment that the issue of surgery can be looked at with any degree of certainty with regard to its need and about the very nature of the operation that is required.

It is up to Indian women, particularly, the educated urban woman to take a lead in such matters. Breast cancer awareness is not merely being aware of the problem but also being aware of the dimensions of care available today.

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