By Dr.Mandeep Singh
Some well known Indian female celebrities that have battled cancer and came out victorious are Manisha Koirala, Sonali Bendre, Lisa Ray, etc. The two most common cancer plaguing women in India are breast and ovarian cancer. A 2020 study in the Indian population showed that breast cancer contributed to 27.6% of all cancers while ovarian cancers contributed to 6.2% of all cancers in women. The study also shows that the incidents of death from breast cancer versus new cases identified has also increased to 56% which is much higher than the percentages from developed countries. A maximum number of Indian women affected by breast cancer fall between the age group of 40-50yrs while their western counterparts fall within the age group of 60-70yrs. In addition to this, around 70% of the patients identified with breast cancer in the United States are in Stage I of the disease, while in India, a large number of women are identified in the advanced stages making treatment and outcome of such patients more complicated.
In the western population, hereditary breast cancer comprises 10 to 15% of the total breast cancer. The data in India is limited, it varies from 3 % to 24% in certain reports. More younger women are getting breast cancer in India along with an increase in a certain variety of breast cancer known as triple-negative breast cancer (TNBC). BRCA related breast cancers are known to manifest in the younger age group in form of TNBC, henceforth it is being expected that the Indian population will have higher prevalence of hereditary varieties of Breast cancers.
A good example of identifying early cancer risk based on familial history can be highlighted in the case of the well known international celebrity, Angelina Jolie. On May 14th, 2013, she shared the news of her ‘bilateral risk-reducing mastectomy (complete removal of both breasts to ensure prevention of cancer), based on having a strong family history and being tested positive for her BRCA1 pathogenic variant status. This decision led to enormous interest in hereditary breast cancer/genetic testing. The actress decided to undergo ‘risk-reducing prophylactic double mastectomy followed by bilateral Salpingo-oophorectomy (removal of both ovaries with fallopian tubes) in later years.
Addressing the hereditary variety of breast cancer is done very methodically. If a woman has doubts about having a family history of cancer, especially breast/ovarian, she is asked to visit a genetic counsellor which ascertains the actual risk and need for getting tested for BRCA1/2 and related genes. If the test result is negative the woman has advised a high-risk screening protocol according to the familial risk; if unfortunately, she tests positive for harbouring a mutation, she is advised high-risk screening protocol which includes self-breast examination, clinical breast examination, Ultrasound breast and vagina, serum marker CA125 test and MRI Mammogram.
Such a patient is asked to regularly come for regular follow-ups while living her normal life, start a family, be encouraged to proceed with nursing the children, etc. Once the patient reaches her early 40’s and lactation is over, she is given the option of risk-reducing removal of breasts. The procedure is defined as removal of ductal tissue and fat from the breast site with preservation of overlying skin and nipple and replacing it with either an implant or autologous tissue transfer from back/abdomen/buttock or thigh. With 3D planning, we can preempt the size and shape of the breast according to the woman’s choice.
The thought process while performing this risk-reducing breast removal is to minimize the cancer risk and also provide a better breast back. Prophylactic Mastectomy decreases the risk of death due to cancer in BRCA positive females by around 90%. For women with mutations in other genes except for BRCA, it is generally not advised. Also, it is normally recommended to be done around the age of 40 years when lactation is complete and ageing sets in. Early removal of ovaries can increase the risk of heart disease and osteoporosis in a woman.
With the advent and availability of an Indian genetic profile-specific gene panel today, the possibility to obtain high sensitivity and specificity for both hereditary as well as sporadic cancers have increased. The availability of such tumor panels in India will help provide younger women with a familial history of the disease, as well as for others that have a predisposition to cancer due to environmental factors or habbits, with better treatment options. Such advanced diagnostic measures will ensure that the disease can be managed through personalised and precise medicine.
Hence, while the incidence of breast cancer in India is high, it’s important to know that awareness is the key to early detection of the disease and its timely treatment. For further information, it’s important to reach out to your physician who can provide you with additional inputs about the diseased and appropriate testing options.
(The author is Clinical lead, Art of Healing cancer and Sr. Consultant, Fortis Hospital, Vasant Kunj, New Delhi. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)