'Breast cancer: Early screening key to boosting survival rates'

A recent study published in BMC Public Health says that in India, only around 1% of women aged 45 and above undergo mammography periodically. And despite the US having more breast cancer cases, delayed diagnosis makes more women die of the disease in India. Dr Divya Khanna, study author and in-charge of the preventive oncology department at Tata Memorial Centres, Varanasi tells Durgesh Nandan Jha how early diagnosis is crucial to improve survival rates

Why is India’s breast cancer survival rate lower than developed countries?

It’s because a significant number of cases here are diagnosed at an advanced stage, which limits treatment options and reduces survival chances. Limited awareness about the importance of screening and early diagnosis — coupled with lack of access to quality healthcare services — in rural India is part of the reason. In our study, we found that while breast cancer rates were higher in the urban population, mortality was disproportionately higher among rural women. Fear and stigma also leads to late detection. Cancer fatalism needs to be addressed as early detection can significantly increase the chances of cure and long-term survival.

The mammography rate in women aged 45 and above is as high as 84% in Europe, the US. Why is it only 1% in India?

Unlike developed countries, where screening guidelines and preventive healthcare are widely practised, awareness campaigns in India are still evolving and more efforts are required to reach all sections of society. In many high-income countries, mammography is systematically offered through public health initiatives. In contrast, breast cancer screening in India is still limited to tertiary care settings. And even though govt schemes and non-govt initiatives support breast cancer screening, mammography remains costly and inaccessible for the poor.

More women in Kerala and Tamil Nadu undergo mammography than in Delhi, Haryana, Uttar Pradesh, Odisha and Assam among others. Why?

Kerala and Tamil Nadu have higher literacy rates, better health awareness, and stronger healthcare systems, making screening more common. These states also have focused cancer research and govt-led early detection programmes like the Tamil Nadu Health Systems Project. But states in the north and northeast have hard-to-reach areas, limited healthcare facilities, and low awareness.

What can the govt do to improve mammography rates? Are there other screening methods?

Nationwide campaigns are essential to educate women about early detection and regular screening. More mobile screening units and mammography facilities, particularly in rural, remote areas offering free or low-cost services through govt healthcare schemes, will help make screening more accessible. Mammography is the gold standard for early detection in developed countries, but Clinical Breast Examination (CBE) is the govt recommended screening method for Indian women aged 30-65. A trial by Tata Memorial Hospital, Mumbai, showed CBE significantly reduces cancer mortality, especially in women aged 50 and above. To make CBE widely accessible, it’s crucial to train Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs).



How does treatment outcome change as the disease progresses?

In the early stages, when the cancer is small and hasn’t spread, treatment is often very effective and many women can be cured. However, as the disease spreads to nearby tissues or other body parts, it becomes harder to treat and control. Advanced breast cancer usually requires a combination of surgery, chemotherapy, radiation, and targeted therapies. Despite these efforts, chances of a complete cure decrease. That’s why early detection is crucial.

Are breast cancer treatment outcomes in India comparable to developed nations like the US?

Breast cancer treatment has come a long way in India. Earlier, treatment mainly involved radical surgeries like removing the entire breast (mastectomy). Now, breast conservation surgeries can remove only the tumour while preserving the rest of the breast, which improves quality of life. Besides surgery, there are targeted therapies, genetic studies like MammaPrint, tomography for precise imaging, and even robotic surgeries that are on a par with those in developed countries like the US. However, only select centres in India provide these advanced treatments, which can be quite expensive. These innovations must be made more cost-effective and widely available across India.

The central govt plans to utilise Ayushman Arogya Mandirs to screen people for breast cancer. What are the must-haves to run such a facility?

Ayushman Arogya Mandirs must have trained healthcare workforce, including ASHA and ANM workers skilled in CBE. Basic diagnostic facilities like ultrasound machines and access to mammography where feasible are also crucial, especially for higher-risk populations. A well-defined referral and follow-up system is vital to ensure patients needing further treatment can access higher centres without delay.

What preventive measures would reduce the risk of breast cancer?

A healthy lifestyle is key — eating a balanced diet rich in fruits, vegetables, and whole grains, staying physically active, and maintaining a healthy weight. Limiting alcohol intake and avoiding tobacco use can also greatly reduce risk. Regular breast self-examinations and CBE are crucial for early detection, especially for women aged 30-65 years. Women with a family history should consider genetic counselling and testing. Breastfeeding for longer durations has also been shown to lower breast cancer risk. One must participate in screening programmes and seek medical advice if any lump, pain, or changes in the breast are noticed. Early detection saves lives.