The cancer disease in India is rising one in twelve (men and women up to 64 years). In 2001, out of 800000 cases diagnosed 80000 were breast cancer ie. one in ten cases. Average incidence is occurring at 16/100000 (22-28/100000 in urban area). Number one is urban area women in breast cancer. The problem in developing countries like India is that women do not come forth with their complaints. There are various reasons for the same.

Shame and neglect: Women still feel inhibited to consult a doctor especially a male doctor as regards the problems regarding the breast. They are also so overburdened with the family that they do not pay attention to themselves and neglect their own problems.

Lack of accessible healthcare: Especially in rural areas, this is a big problem with sparse healthcare facilities. The non availability of a trained person delays the diagnosis sometimes with fatal consequences.

Affordability: Lack of financial resources as a result we have a situation in which cancers are diagnosed late and hence the survival case is poor. The following chart gives us an idea of the reason for poor survival in developing countries:

Causes
- Increasing age
- Family history
- Exposure to female reproductive hormones
- Dietary factors
- Benign breast disease

Environmental factors

- Family history
- Hormones
- Late menopause
- Early menarche
- Late first pregnancy
- No breast feeding
- Diet?
- Obesity?
- Radiation exposure?

The most basic reason is exposure to menstrual cycles since the breast is a hormone sensitive organ. If the breast is exposed to more cycles then the chances of developing breast cancer are higher. Hence early menarche, late menopause, less children or no children, no breast feeding all contribute to the increase in incidence we see in breast cancer.
Contrary to perception, there is no difference in the incidence as regards the poorer sections of society though there is a distinct rural urban divide - the incidence is much higher in the urban areas and it is the most common cancer in urban women overtaking cervical cancer in the late 1990s.

Although these are signs at presentation, a lot of patients still present with a large mass involving the entire breast, ulceration and wounds over the breast, development of glands in the arm pit and in extreme cases involving the spread of cancer with pain in the bones, difficulty in breathing or headache or water in the abdomen.

How do we confirm diagnosis?
Mammography is an X-ray and sonography procedure which is extremely sensitive in diagnosing the problems of the breast. More than 90 per cent of the lesions of the breast can be diagnosed using this procedure. It is a good tool for both screening and diagnosing breast cancer.

Fine needle aspiration cytology (FNAC)
In this a diagnosis is made by aspirating the contents of the tumour with a needle and examining the cells under a microscope. It is relatively painless and a good tool for a primary diagnosis.

Biopsy
If an FNAC fails then we take a small piece or the entire lump if it's small and send it for examination. There is a myth that a biopsy causes spread of the tumour. Nothing can be further from the truth. A biopsy is an essential part of examination and without that one cannot proceed further. It does not cause cancer cells to spread.

Other tests
The doctor may advise other tests like X-ray of the chest, sonography of the abdomen, bone scan and other blood tests. These are for checking if the tumour has spread beyond the breast and for checking the fitness for surgery.

Is breast cancer curable?
Most women who are treated for early breast cancer go on to live healthy and active lives.

Types of treatment: Surgery; Breast saving surgery; Breast removing surgery with or without reconstruction (plastic surgery); Chemotherapy; and Radiation

Surgery
In previous years, surgery involved removal of the entire breast in all cases. This procedure was called as 'mastectomy' and for some patients would be very traumatic and few patients refused to undergo treatment if it was a mastectomy. Nowadays we can conserve the breast in which the tumor and a part of the normal breast beside it are removed. Along with this the glands in the armpit are also removed.

In some patients, where conservation is not possible, there is the possibility of plastic surgery in which the tissues from other parts of the body are used to reconstruct the breast. This gives a cosmetically acceptable appearance.

Chemotherapy
Chemotherapy is the most feared of cancer treatments. There are multiple myths surrounding chemotherapy ranging from "burning of the entire body" to "chemo involves giving of acid ". Most of these are baseless and once patients start chemo they themselves understand that these are just myths. Chemotherapy involves drugs which kill cancer cells. These are given through IV fluids. There are definitely some side effects most common of which is hair loss. There can also be nausea, vomiting, weakness, fatigue and in severe cases life threatening infections. But all of these side effects including hair loss are reversible. They are not permanent and last only when the chemo is on. Side effects like nausea and vomiting are now countered extremely well with the help of supportive drugs and there is no need to fear them. The advance in supportive medication in chemo has resulted in patients tolerating chemo better.

There are also 'targeted chemotherapy' drugs which act directly on the tumour and thereby reduce side effects.

Radiation
Radiation involves treatment with radioactive rays. In this speciality also there have been very good advances resulting in the reduction of side effects. For instance now the radiation is targeted towards the tumour resulting in the surrounding areas being affected less.

Rehabilitation
Cancer treatment now concentrates not only on curing patients but also trying to ensure that their quality of life is excellent and they continue their life with normalcy.

Issues like the swelling of the arm post treatment, requirement of breast prosthesis and psychological counselling are now given importance and are a part of the treatment.

Screening
It is a procedure by which normal people are screened for the presence or absence of breast cancer. It has been found to be extremely effective.

Prevention
There is no prevention for breast cancer. The only way to cure is by early diagnosis. However, there are few general tips: Healthy lifestyle - eat right and exercise; Use fresh fruits in diet; Try to avoid obesity; Avoid too much of stress; Be sensitive towards your own body and do not neglect it.

(The author is oncosurgeon of Fortis Hospital, Mulund, Mumbai)