Understanding the surge and solutions for breast cancer cases among India's youth

Globally, breast cancer ranks as the most prevalent form of cancer among women. According to the World Health Organisation, over 20 lakh females were diagnosed with this condition in 2020, with over 6.5 lakh succumbing to the fatal disease. Consequently, the incidence of breast cancer has increased in India as well.

Once considered a disease of the elderly, it's now seen to affect younger women of age less than 40, informs Dr Latika Gupta, Consultant Histopathologist, Metropolis Healthcare, Mumbai. The occurrence of breast cancer has been observed to be higher in urban areas as compared to rural ones. Alarmingly, this statistic is set to plummet as per medical experts.

To investigate why the cases of breast cancer are set to rise, Midday spoke to Mumbai-based doctors on the occasion of Breast Cancer Awareness Month, observed in October, each year. The month is marked to educate the public, particularly women, about the importance of breast health, self-examinations and regular screenings for early detection.

Cases of breast cancer among younger adults set to rise
The anticipated increase in breast cancer cases among younger women and adults can be attributed to various factors. "The use of hormonal birth control methods and hormone replacement therapy can affect hormone levels and potentially influence breast cancer risk," informs Dr Kshitij Joshi, Consultant - Medical Oncologist, SRV Hospitals, Goregaon.

Other factors contributing to the rise include delayed childbearing and having fewer pregnancies, which increase susceptibility to breast cancer. Genetic predisposition and family history significantly impact risk and some individuals carry genetic mutations that heighten their susceptibility. For instance, daughters or sisters of women with breast cancer have more chances of developing breast cancer.

Not only breast cancers, but these genetic alterations also predispose women as well as men for the development of other cancers of the reproductive tract including those of the ovaries, pancreas, prostate, etc., informs Gupta. Environmental factors, such as exposure to endocrine-disrupting chemicals found in plastics and pesticides, also play a role.

Additionally, modern lifestyles characterised by poor dietary choices, heightened alcohol consumption and reduced physical activity are contributing to elevated breast cancer risks. Among Indian adults, younger women are the most vulnerable to this form of cancer, with a rise marked by 5 per cent each year, adds Joshi.

Symptoms of breast cancer
Breast cancer can present with various symptoms, although some individuals may remain symptom-free.

Women should be aware of the following changes:
1. Lumps or bumps in the breast that are thickened from the rest of the surrounding tissue
2. Discharge from nipple, usually bloody
3. Recent changes in nipple like pulling in of nipple
4. Changes in breast size or shape
5. Alterations in the skin of the breast such as dimpling, crusting, scaling and reddening
6. Persistent breast pain
7. Unexplained tenderness, warmth, or itching in the breast

Common risk factors associated with the development of breast cancer
Lifestyle alterations, familial or genetic tendencies and hormonal or reproductive factors are the important risk factors in the development of breast cancer.

1. Lifestyle factors include obesity, low physical activity, excessive consumption of alcohol and smoking which predispose to breast cancer.
2. Use of hormonal contraceptives, premature menopause, late age of first pregnancy (> 35 years), no breastfeeding and high parity are associated with more chances of developing breast cancer
3. Lastly, genetic alterations commonly in BRCA1 and 2 genes are the most common cause of hereditary and familial cases of breast cancer.

Importance of regular breast self-examination
Breast Self-Exams (BSE) play a significant role in early awareness and detection. They encourage women to become familiar with their own breast tissue, helping them notice any changes in size, shape, or texture. Performing BSEs on a monthly basis, ideally after menstruation, is recommended.
On the other hand, mammograms are X-ray images that can detect microscopic changes, including tumors too small to be felt in a self-exam. Mammography serves as a valuable screening tool for asymptomatic individuals, facilitating early detection of breast cancer.

Typically, women commence mammograms around age 40 or earlier if they have higher risk factors, continuing regular screenings based on individual risk and guidelines, shares Joshi. The importance of these methods lies in the fact that early detection of breast cancer is associated with improved survival rates and more conservative treatment options.

Breaking barriers to early detection of breast cancer
Reducing the stigma associated with breast cancer and promoting open dialogue encourages women to seek help when needed. This can be achieved by tailoring outreach to diverse communities with cultural sensitivity aimed at enhancing early detection efforts. Identifying individuals at higher risk due to family history or genetic factors and offering appropriate counselling and screening also improves early detection.

Breaking down barriers to early breast cancer detection necessitates a multi-pronged approach. First and foremost, education and awareness initiatives are essential, dispelling myths and highlighting the benefits of regular self-exams and mammograms. Ensuring access to affordable healthcare, especially for underserved populations, is crucial, encompassing affordable mammograms, clinical exams and follow-up care.
Detecting breast cancer early is crucial for reducing the likelihood of severe consequences. One can achieve this by performing monthly self-examinations of their breasts. It's also important to adhere to the recommended mammogram schedules based on one's age and individual risk factors. Make sure to be aware of your personal risk factors, such as family history and genetics.

Treatment options available for breast cancer
The choice of treatment for breast cancer is highly individualised and depends on several factors, including the type of breast cancer, its stage and the patient's overall health. Treatment options for breast cancer include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy and immunotherapy.
The choice of treatment is determined basis the type and stage of cancer, knowing whether the cancer is hormone receptor-positive, HER2-positive, or triple-negative. The patient's overall health, age and personal preferences also plays a role in decision-making.

The treatment plan is often a combination of these options, tailored to the individual patient. It's crucial for patients to have open discussions with their healthcare team to understand their treatment options, potential side effects and expected outcomes, so they can make informed decisions. Breast cancer treatment is continually evolving, with ongoing research and clinical trials leading to more effective and less invasive approaches.

The following treatment modalities can be used in isolation or in combination:

1. Surgery can be conservative with sparing of breast to total removal of breast tissue.
2. Chemotherapy is the use of specific medicine to kill cancer cells and can be given before or after surgery to shrink tumor mass.
3. Radiation therapy utilises high-energy beams that are used to destroy cancer cells. These radioactive beams can be given externally or placed internally within the tissue.
4. Hormonal therapy is used by blocking the hormones that fuel cancer cell growth. These mostly include drugs that target either estrogen or progesterone receptors (ER and PR).
5. Immunotherapy is a method that involves drugs that effectively use the body's immune system to fight against cancer cells.
6. Targeted therapy also uses drugs that attack specific cancer cells having specific abnormalities. HER2-positive cancers usually benefit from such kinds of therapies.

Lifestyle changes to reduce the risk of breast cancer
Reducing the risk of breast cancer involves several lifestyle changes and behaviours. Maintaining a healthy weight is crucial, especially after menopause, and can be achieved through a balanced diet and regular exercise. Limiting alcohol consumption, regular physical activity and a healthy diet that includes fruits, vegetables, whole grains and lean proteins while limiting processed and red meat are recommended.

Stress management techniques such as mindfulness, yoga, or meditation can improve overall health. Regular breast self-exams and adherence to mammogram guidelines for early detection are also essential. For individuals with a family history of breast cancer, genetic counseling and testing can assess risk and aid in developing a personalised screening plan.

However, it's crucial to understand that these lifestyle changes and measures can lower the risk but don't guarantee prevention. Regular screenings and early detection remain critical and personalised guidance from a healthcare provider is recommended for risk reduction strategies.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist or your physician for personalised guidance.