Cancer rates in India have more than doubled in the past 26 years, and a significant part of this increase has been in breast cancer. Breast cancer is now the most common cancer in India, and the country shoulders one of the largest burdens of breast cancer in the world. In 2018, there were a reported 162,468 new breast cancer cases and 87,090 deaths due to breast cancer.
Even more concerning is the high rate of breast cancer in younger age groups. In India, the rate of breast cancer cases for women in their thirties and forties is on the rise and already more than double that of the United States. Additionally, India has the highest rate of the most aggressive breast cancer in the world, triple negative breast cancer.
At a global symposium hosted this month by Columbia Global Centers in Mumbai, leading public health and medical experts from NewYork-Presbyterian Hospital/Columbia University Irving Medical Center and institutions across India discussed these alarming trends, new research, and potential interventions.
Lack of awareness, lack of screening
Breast cancer, including its risk factors and symptoms, is relatively unknown across the population, and it still carries a stigma. There are also logistical challenges, including poor transportation, expensive healthcare, and a short supply of radiologists – India has roughly one radiologist per 100,000 people; the United States has 12. Because of these obstacles, women often do not seek medical help until symptoms start appearing.
“The big difference between India and the United States that impacts statistical comparisons, however, is that there is no uniform breast cancer screening in India,” says Dr. Mary Beth Terry, PhD, professor of epidemiology at Columbia’s Mailman School of Public Health and co-leader of the Cancer Population Sciences research program at the Herbert Irving Comprehensive Cancer Center (HICCC).
“Without screening mammography, breast cancers are detected from either a self or clinical breast exam, which means it’s at a later stage than tumors detected through screening mammography,” says Terry.
More than half of patients with breast cancer in India are diagnosed in advanced stages, when survival is limited. In the United States, 90 percent of women with breast cancer survive five years; in India, only 66 percent survive.
Environmental factors could be at play
Why are breast cancer rates rising, especially in young women? One possible explanation raised at the symposium is that women bear the brunt of environmental exposures like air pollution that could be putting them at a higher risk for cancer.
“Environmental exposures, including air pollution, can disproportionally affect women during vulnerable time periods like puberty, pregnancy, and menopause,” says Dr. Terry. “This is certainly true for breast cancer and some of the environmental exposures in the United States that have been studied by our group and others.”
Terry and Jasmine McDonald, PhD, assistant professor of epidemiology at Columbia’s Mailman School of Public Health and member of the HICCC, discussed additional recent studies from their teams underlining the need to understand the effect of exposure to air pollutants, pesticides and other toxins on women’s health during pregnancy and menopause.
“The early onset of breast cancer in Indian women is a cause of serious concern,” says McDonald.
The experts at the symposium outlined several immediate and long-term steps to further understand and begin to curb these alarming trends. Dr. Roshni Rao, chief of breast surgery at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, called for a national triple negative breast cancer (TNBC) breast registry. Experts across India who attended the conference pointed to ongoing trials in India investigating the use of community health workers to conduct clinical breast exams as a potential way to improve earlier detection. Additionally, the researchers from Columbia are looking to establish a collaboration between Columbia and local experts geared towards both research and awareness focusing on the role of environmental exposures in breast cancer.
-Kristina F. Mesoznik