Breast Cancer Screening in India - Current Situation & Possible Solution

Breast cancer is the commonest cancer in Indian women and accounts for about 25% to 33% of all cancers in women from urban data, which if converted into actual numbers, are very high. Combine this with the fact, that over 50% breast cancer patients in India present in stages 3 and 4, which definitely impacts survival. The risk of getting breast cancer has tripled over the last half-century. For most women, breast cancer probably begins very early in life, long before they have been educated about prevention strategies. One way we can beat breast cancer is through early detection, which translates into a much greater likelihood of cure.

According to WHO’s latest World Health Statistics (WHS), less than 5% women, aged 50-69, underwent screening by mammography in India between 2000 and 2003. Healthcare is low on priority and even in major cities screening is an unknown entity for most. This results in most people presenting only when symptomatic, and on an average, most ‘symptomatic’ cancers are stage 2B and beyond (significant numbers in stages 3 and 4) and here comes the pivotal role of screening.

A high state screening take-up has been accounted for in UK and US, yet it is nearly NIL in India. Organized breast cancer screening services have showed a decrease in mortality in the Western world. Today, the most widely used tools globally for breast cancer examination are mammography/sonography, clinical breast examination (CBE), and breast self-examination (BSE). Mammography and regular CBE can result in decreasing the toll of mortality through down-staging of breast cancer of asymptomatic women but its expensiveness and not-so-easy to-use methodology hamper its usage in countries like India. Studies have suggested that BSE can be used as a tool of creating breast health awareness among women and trained female health workers can play a promising role spreading this learning among women to complete BSE.

Studies regarding the health seeking attitude of the women in London and Canada suggested that resident Indians majorly reported emotional rather than logistic or practical barrier to seeking medical help. These findings suggest that health seeking behaviour amongst Indian women are majorly governed by emotional status and may not be influenced by their health related knowledge. If women from affluent society are facing  problem regarding disease screening then we cannot expect much from the women living in the rural with remote access to even primary healthcare facilities and other priorities over there health issues. So alongside expanding the information of these ladies we need to reinforce their enthusiastic status and could be only done by the community outreach awareness program. This demands a shift of our screening program from tertiary care facilities to primary healthcare facilities and even at the door step of the beneficiaries.

As a healthcare service provider, it is our duty to handle the circumstance at all dimensions either at the network or the essential medicinal services offices.. The whole scenario demands depolarization of our resources towards the community, mainly women living in villages, as for catching big fish one have to go far in the sea instead of betting at the shore.