Fear Not the Cancer
screening for breast cancer is a
Treatment, Fear the Disease
DR KANCHAN Kaur
Specialist oncoplastic breast surgeron
MBBS( Gold medallist ) MS MRCS Edn
Medanta Hospital gurgaon.
Dr Kanchan Kaur, Director Breast
Surgery at Medanta hospital
in Gurugram , is an expert in
Oncoplastic breast surgery. She has
trained at leading Breast centres at
London, New York and Paris. Dr Kaur
has been instrumental in setting up the
Breast Services Institute at Medanta,
Hospital . She trains blind girls to
become Medical Tactile examiners
under the ‘Discovering Hands
programme’ . She is a strong advocate
for spreading cancer awareness. She
works closely with cancer NGO’S and
is extensively involved in outreach
programmes in the community .
You have specialised in breast cancer and
even studied abroad giving you exposure
to the comparative situation of the disease
viz-a-viz India and rest of the world. How
alarming is the situation?
Increasing number of cancer cases are
definitely becoming a socio-economic
challenge and burden on India. Data from
studies indicate that metro cities like Delhi,
Bengaluru, Mumbai are showing highest
numbers of the disease which is lifestyle
related. In the west, people are more aware
and also they have accessibility to
standardised population based screening, so
the cases are detected at very early stages. In
contrast , majority of the cases in India are
detected in late stages. In India, the peak of
breast cancer is seen amongst women in
their 40’s and 50’s, which is a decade earlier
than what is seen in the west. Also, the
incidence of young breast cancer( under the
age of 40) is much higher , at approximately
16% as opposed to the west , where young
breast cancer accounts for 6% of all breast
cancers diagnosed. .Every week we end-up
seeing a girl in her late 20’s or 30’s with
breast cancer which is extremely worrisome.
The other problem is that women in India
decisions are taken by the husband or the
come to us in advanced 3-4 stage of cancer
because the symptoms of the disease are
passed off as some momentary discomfiture
or ignored till the pain becomes unbearable.
Breast cancer is now the commonest cancer
amongst women that has grown to epidemic
like proportions displacing cervical cancer
to the second place. Lack of awareness about
the disease, is proving to be a severe
impediment.
Why are women in India prone to breast
cancer making it the largest non-
communicable disease in the women
population?
The high number of cancer cases is the
outcome of lifestyle changes which has
deteriorated and are impacting young girls
and women. Women choosing not to have
children, late pregnancies, not breast
Though there is increasing awareness and
feeding, food intake that is not nutritious,
indulging in junk food, substance abuse,
poor hygiene, and sedentary life where there
is hardly any exercise are among the many
causes aggravating the cell health and the
body. Breast cancer is multifactorial and it is
difficult to pin point one definitive cause for
it , other than in those women who have a
family history and a faulty gene which leads
to development of cancer
How important is screening for detection
of breast cancer?
Screening means finding the cancer before
it’s symptoms become apparent . It is of
paramount importance to be able to detect
breast cancer at its earliest stages of
inception. When breast cancer is detected
and treated in early stages , cure rates can be
in excess of 90% . The gold standard for
mammogram. This is an X ray of the breast
which is offered to women aged 40 and
above every 1-2 years . However this
requires high degree of specialisation , and is
costly and thus is not feasible in the
community at large in India. It is extremely
important , therefore to make Indian women
aware about the need for self checking of
their breasts and reporting symptoms early
to their doctors.Girls from the age of 16-17
should be taught to do self-examination at
least once a month, and continue with this
practise for life. For those , who have access
to mammogram facilities, it is
recommended that they get their screening
done regularly after the age of 40 .
What is your suggestion on how to go
about the mass screening drive?
The government has to realise that cancer
severely impacts the socio-economic fabric
and that the healthcare system is grossly
understaffed to handle this surge in cancer
cases. Once the government sets up regional
cancer centres to screen women a marked
change would be visible over a period of
time because the change cannot be brought
about overnight. Only the media can
quicken spreading awareness among the
masses and make an impact in controlling
the situation. Personally, I feel, we need to
talk a lot about self-examinations, screening,
mammography and so I urge my journalist
friends to at least talk once in a month about
cancer, its symptoms, how to check it and
the latest treatment available; which would
definitely have the desired effect that we all
hope for.
What are the social hindrances that
compel women to suffer?
One must understand that cultural
traditions, social taboos, family pressure etc.,
are damning for a woman if she has cancer
symptoms and it remains undetected and
untreated. The society fails to understand
that woman’s health is paramount because
only if she is healthy can she take care of the
family. The age between 30’s and 40’s are the
most productive for women, a time when
she is stabilizing or rising in her career, or
when she is tending to adolescent children
and the elderly in the family. If the lady of
the house say around the age of 40 is
detected with breast cancer the family gets
badly affected and brings everything on the
verge of collapse. Women are so caught up
in their careers and family that they ignore
their health and most of them come to us
very late when the damage and disease is far
severe. The other issue is that most women
do not have a say on their own being. The
family when it comes to treatment which is
guided by several reasons such as societal
reaction, financial implications etc.
How important is the role of men in being
supportive of the women in their home?
This is a very important aspect that is often
overlooked. With corporate culture which is
more tolerant, considerate and liberal
towards women in turning the tide and
definitely there is change happening, albeit
slowly. Men should be more proactive, come
out in larger numbers to support the women
in their homes, which are the most
vulnerable as they are left to their fate most
of the time and brought to the hospital at the
last stage. With increased awareness, men
should be equal partners in curbing breast
cancer.
Why is your emphasis on city-bred
women?
The government has a very good healthcare
system for the grassroots and even a lot of us
have involved Aanganwadi workers to
screen the community. But the issue is that
of the women living in cities, because there
are no targeted programmes for them.
Women, especially career women, are more
caught up with juggling their profession and
home as a result they keep postponing their
check-up even if there is any discomfiture as
a result of which they come to us when the
disease is in an advanced stage and chances
of survival is bleak.
What is you observation on the
psychological impact on women on breast
removal?
This is the reason why we insist on self-
examination, getting screened, and get a
mammography done when the slightest of
problem is noticed. Early detection saves
women from removal of the breast. When
breast cancer is treated at a specialist centre,
there are counsellors, physiotherapists,
Onco-specialists, etc who can talk to the
patient and create the confidence to go
through the treatment. Breast reconstruction
options are now available to women and
they must be given a chance to explore this
option. It is also very important for young
women to undergo counselling for fertility
preservation because they are risk of
infertility after chemotherapy. Issues
surrounding sexuality and other side effects
of treatment must also be discussed. This
understanding can come from only a proper
multi-disciplinary set-up offering
comprehensive cancer treatment which is
patient specific, because the entire service
has to start with the patient and the family.
families are becoming more supportive, yet
the decision for the woman is mostly taken
by the husband or the family, which is very
demoralising for the patient as she has no
say in the treatment for herself.
You are deeply involved in the Breast
Services Institute at Medanta. How is the
facility standing out with its services?
Breast Services Institute is unique because
every staff member whether they are
oncologists, pathologists, radiologists, each
one of them is a highly specialised in breast
cancer treatment. We provide a holistic
approach to cancer management , ranging
from top end diagnostics, to state of the art
surgical and medical care to ancillary
support services like counselling and
physiotherapy . Diagnosis, treatment and
counselling imparted in the speciality is at
par with international standardised protocol,
meaning it is evidence based and goes a long
way in establishing excellence.
We run a breast screening programme in
the hospital and in the community along
with extensive awareness campaigns , which
in turn impacts the treatment outcome
positively.
The breast team at Medanta is committed
to the goal of early detection , standardised
treatment and ensuring that the entire
journey from diagnosis to treatment and
follow up is made easy for the patient and
their family
What hope do you bring to the affected
women?
Breast cancer treatments have become very
successful and there is great hope for those
diagnosed with cancer now. However , it is
important for cancer to be detected in time.
I strongly believe that we need a very
stringent awareness programme in the
community. We need to instill the
importance of self breast examination in
girls from a young age . For women aged 40
and above, there should be facilities that
offer screening, and because cancer is a very
specialised branch, we need more trained
specialists who are involved in diagnosing
and treating breast cancer . Women should
know that there are advanced techniques
available now like the option to save the
breast when cancer is removed and also the
option of breast reconstruction .
Creating centres of excellence in cancer care
is the need of the hour and educating
women to come in time and avail such
treatment is at the root of early diagnosis
and successful treatments . Remember ,
cancer is most often curable if detected early
and there is no need to fear it .