Detecting breast cancer in the young is difficult and that’s bad news for India’s under-35 patients

Young and at risk

 It wasn't just Venezuela that mourned the death of Eva Ekvall on December 17 last year. The former Miss Venezuela was just 28 when breast cancer claimed her life, iterating to millions of women the risk the disease poses even to those below 35. 

    In India, with its abysmal health care and pervasive poverty, it could just be worse. Health practitioners are already speaking in worried whispers about the rising number of patients way ahead of the age barrier. In 2001-03, around 8% of the female breast cancer cases in Delhi were in the 20-34 age group. "In the last three years, around 10% of my patients have been under 35," says Dr Ramesh Sarin, senior consultant (oncology), at Delhi's Indraprastha Apollo Hospital. "The incidence would be just 0.3% in the West." 
    A major reason for the higher incidence in India is the country's so-called 'demographic dividend'. "There are more younger people here, plus cancer strikes women a decade earlier in developing countries like India than in the West," adds Sarin. 
    Other triggers, say experts, are the dramatic changes in women's lifestyle and reproductive behaviour in the last two decades. More and more young urban women are entering the workforce, delaying marriage and first pregnancies. "Other risks include the fact that more women are not breastfeeding, are drinking alcohol and smoking," says Dr Bhawna Sirohi, head of medical oncology at Artemis Health Institute, Gurgaon. "I am seeing younger breast cancer patients in the age group of 23-24 years," she says. Goa, for example, has one of the highest incidences of breast cancer in the country – 36.8 per one lakh population, and reportedly 6% of them are under 30 years. Adding to the problem, say doctors, is the state's large number of single women. 
    But a bigger risk among younger women is detection and diagnosis of malignant lumps that aren't easy due to high density in the breasts. "The glandular part of the breast is in higher proportion compared to the fat surrounding it. The glandular part and cancerous tissue both look white in mammograms. In older women, the glandular part atrophies and is thinned out, making detection easier," says Sarin. So, mammograms may not work for younger women. 
    The positive side is that growing awareness is bringing women to clinics much earlier now. "I am operating on five to seven young patients every month," says Dr Sanjay Sharma, surgical oncologist at Lilavati and S L Raheja hospitals in Mumbai. Most young patients want the affected breast saved. "Younger women get more aggressive cancers, and the risk is high of the cancer coming back if the breast is not removed," adds Sarin. 
    Implications for the future are serious and daunting. The number of new breast cancer cases in India is about 1,15,000 per year, and this is expected to rise to 2,50,000 per year by 2015. The good news, though, is the rising survival rate – the disease is 85% curable, say experts. Diagnosis and treatment in the earlier stages have brought mortality down. The challenge is to catch it early enough. While around 40% of urban cases are diagnosed early, 80% of rural patients come at a late stage. 
    The best way to tackle this issue, advise experts, is to do self-examination at least once a month, 4-5 days after menstruation and get physically examined by a doctor. Also, be aware of high risk factors like family history, early menarche and late menopause. 
SCARY STATS 
In India, 1 in 22 women may develop breast cancer 
In the US, 1 in 8 women may get it 
In 2008, India had 1.15 lakh new breast cancer cases and 53,000 deaths 
In the US, there were 1.82 lakh new cases and 40,000 deaths 
Breast cancer burden in India has almost reached 2/3rds of the US

Ex-Miss Venezuela Eva Ekvall died of cancer