The rise in young breast cancer patients is an alarming situation, needing urgent attention
By: Dr. Balraj Gill
Ashima (name changed), a 19-year-old student lost her mother to breast cancer a few years ago. Lately, she had been experiencing slight discomfort in the right breast. Being cognizant of the family’s medical history, she decided to consult a specialist. To her surprise, a benign lump was detected in the right breast with the help of an ultrasound.
Upon further discussions, the doctor recommended her to undergo a vacuum-assisted breast biopsy (VABB), an advanced technology to root out any remnants of lumps in the breast tissue. Many women in their teens and adolescence become victims of breast cancer and either do not understand the disease cycle or have to rely on invasive biopsies and chemotherapies. If early screening was a norm for every woman despite the age-group, many lives lost to premature mortalities can be saved.
Even though innovative techniques such as VABB are transforming the early detection environment for breast cancer patients, the doctors and the general population remain unaware of the early onset of breast cancer in women. The situation pushes us at crossroads— an increase in patient numbers despite advancements in palliative care. Take, for instance, ”For every 2 women newly diagnosed with breast cancer, one woman dies of it in India.” In yet another startling report by The Lancelot Oncology, it was revealed that the onset of breast cancer in India is peaking at 45-50 years in India. This is a decade younger than the developed countries, a development that could be attributed to genetic and environmental factors.
While globally, the incidence of breast cancer is falling, India reported 1,62,468 new breast cancer cases in 2018, out of which, 87,090 women lost their battle to cancer. This is an alarming rise, particularly when we have developed smarter tools such as imaging tests, mammograms, and surgical biopsy, and more. The prime culprit, lack of awareness, which is leading to a meagre 30% of women in India being screened with early stage of breast cancer in contrast to 60-70% of cases in the developed countries.
In my own experience, an important factor that contributes to the rise in patient numbers is the lack of awareness around breast cancer and its treatment options. More than 60% of women are not comfortable speaking about the illness with their friends and family. Hence, it becomes imperative to improve public perception about the disease profile and ensure that both the medical community and women inculcate the culture of timely screening and detection for breast cancer.
The what, why, and how of breast cancer
Generally associated with post-menopausal women, breast cancer is now equally a threat to women in the adolescent as well as the pre-menopausal stage. In yet another report by the All India Institute of Medical Sciences, it was found that “almost 35% of patients diagnosed with HR+ breast cancer and HER2-negative disease are under the age of 40”.
Whether it’s having a family history of breast cancer, genetic mutations such as BRCA1 or BRCA2, medical history of radiation therapy or lifestyle choices, women of all ages are susceptible to a disproportionate burden of breast cancer. A study by The New England Journal of Medicine claims, “Younger patients have been a particular concern, because breast cancer is known to be more aggressive and associated with poorer prognosis in younger women than in older women.”
From lumps, change in the size, shape or appearance of a breast to flaking of the pigmented area surrounding the nipple (areola), the early symptoms of breast cancer can vary from one patient to another.
For millions of women under the purview of breast cancer, we need to stress the highly preventable nature of breast cancer. Following regular screening programmes, starting as early as teenagers are the key to minimising mortality risks.
Conventionally, a patient is recommended to undergo a mammogram to detect abnormal cells in the breast tissue. Since no two lesions are similar, there have been instances wherein the abnormalities are too small to be seen or felt. In such cases, a mammogram cannot be the optimal screening procedure. For example, in the case of younger women with dense breasts (presence of more fibrous and glandular tissue), a mammogram might make the glands appear as white and can obscure the appearance of tumors.
Hence, we need sophisticated screening techniques that can guarantee the detection of any unattended malignancies. Thanks to scientific advancements in the field of oncology, minimally invasive techniques to detect malignancies, are now possible. A woman has to no longer be fearful of complications associated with open excisions, as the VABB has revolutionised the detection procedures by ensuring no possible lesions in the future. Let’s understand how a technology like VABB can benefit women of all ages from progressing to later stages of breast cancer.
Approaching breast lesions with smarter techniques
A cornerstone in breast cancer detection, VABB helps in collecting enough specimen to provide an accurate visualisation of the lesion with a single incision. Performed under local anaesthesia, the procedure is painless, minimally invasive, and risk-free. The technology can be used under sonographic, mammographic, and magnetic resonance imaging guidance and allows a doctor to observe even the smallest lumps in the breast tissues.
Furthermore, in women with multiple cysts and/or minuscule lumps, relying on contemporary techniques such as ultrasound cannot be considered as the ultimate solution. One of the most striking features of VABB is that it can detect multiple lesions in a single 25-minute screening procedure. Not only does it save time, but also allows detection of benign as well as malignant breast lesions. The minimally-invasive technique leaves minimum to no scars on the skin. While technologies such as VABB can target lumps of all sizes and shapes, the medical fraternity believes that the disease burden can be controlled only if the awareness level rises. To build an environment for early screening programmes, there is a critical need for commissioning nation-wide campaigns to educate women and caregivers about the disease profile, better. There needs to be an understanding that having one or more risk factors does not guarantee the development of breast cancer. Having said that, it’s imperative to have a realistic understanding of the life cycle of the disease in order to action timely prognosis. The knowledge will help improve chances of survival and lead a better quality of life after treatment.
About the author
Dr Balraj Gill is the Senior Consultant Radiologist at Indraprastha Apollo Hospital, Delhi.