As breast cancer incidence rises, doctors raise importance of early detection, need for women to be breast aware

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One in 19 women in Chennai are at risk of getting breast cancer in their lifetime: 0 to 74 years of age*. Compared to the rest of Tamil Nadu, the city also accounts for the highest Crude Incidence Rate (CIR) of breast cancer at 51.8 per 1,00,000 population; indicating that more than one factor is driving the rising incidence of breast cancer, data from the Tamil Nadu Cancer Registry Project 2019, Cancer Institute (WIA) has shown.

V. Sridevi, professor, Surgical Oncology, Cancer Institute, said that the significant increase in the incidence of breast cancer is a real concern. “Women who find a lump in the breast, take six to eight months to seek medical help, and most often, do not meet the right doctor. They must be more breast aware and meet the right doctors for prompt diagnosis,” she said.

What are the main factors that are driving the rising incidence? Dr. Sridevi said that only about 5 to 10% are due to family history of breast cancer, and many factors are at play for the remaining 90%; one of which is changes in lifestyle including diet, delayed childbearing and nulliparity (having no children), which have also increased the risk of breast cancer.

R. Swaminathan, professor and head, Department of Epidemiology, Biostatistics and Cancer Registry and Associate Director, Cancer Institute, pointed out, “Factors such as late age of marriage and late age at first childbirth have become natural reasons for the increase of breast cancer in women. The median age of first childbirth has increased by five to 10 years over the past 30 years. This is because of many reasons such as education, profession and empowerment of women,” he added.

Better awareness levels over the years though, have led to early diagnosis of cancer now. “At the Cancer Institute, nearly 25 years ago, 60% of women came with locally advanced cancer (stage 3). Currently about half of the patients are in the early stages. This is a definite shift,” Dr. Sridevi said.

The State’s Health department has had its learnings from the Community-Based Organised Cancer Screening rolled out in November 2023 at Erode Health Unit District. Piloted in four districts – Erode, Ranipet, Kanniyakumari and Tirupattur, the initiative is all set to be rolled out across the State. T.S. Selvavinayagam, Director of Public Health and Preventive Medicine, said that one of the areas of concern is the hesitancy among those with suspected symptoms to go for higher evaluation for further confirmation.

Diagnosis and treatment

Arvind Krishnamurthy, professor and head, surgical oncology, Cancer Institute, said the presence of dense breasts as evidenced on mammograms has been shown to carry a higher risk of developing breast cancer, and the issue has gained interest with the U.S. Food and Drug Administration requiring all mammograms as of September 10 to include information on breast density.

Surgery remains one of the mainstays of management of breast cancers. “It has been traditionally believed that safe surgery had to entail a modified radical mastectomy or a total removal of breast and axillary nodes. However, evidence over the past several decades has suggested that the option of breast conservation including conservation of the axilla (sentinel lymph node biopsy) is safe in early-stage breast cancers and some studies have even suggested that the results of breast conservations protocols are actually better than protocols entailing removal of the entire breast,” he added.

The growing popularity of oncoplastic surgeries have additionally resulted in enhanced cosmetic outcomes in women who undergo breast conservation surgeries, Dr. Krishnamurthy said.

[*This is the cumulative risk of acquiring breast cancer in a woman’s lifetime from birth to 74 years of age calculated by a formula using summation of 5-year age specific incidence rates up to age 74]