There’s saintliness in necessity aka Majburi ka naam mahatma. In my case, it was witnessing my mother-in-law go through breast cancer. Sixteen years ago, that moment sparked my journey as an entrepreneur in the fem-tech space, but it also opened my eyes to a much larger issue. Despite the alarming rise in cancer rates—from 1 in 25 women hurtling towards 1 in 8 —our society has not sprang into action. We continue to lose women to breast cancer not because the disease is insurmountable, but because access to optimal early detection is virtually non-existent. Adding cancer navigation post-life-saving detection is but a pipe-dream, too high to hope for.
Right now, tools for early detection exist, but for many women, particularly in low- and middle-income countries, the barriers to accessing these life-saving mechanisms remain too high. It is time to address these challenges head-on. With early detection, survival rates skyrocket. Without it, the story is often tragically different. The gap in access to screening and treatment is not just a healthcare issue—it is a social issue, a gender issue, and an economic issue. This article is a call to action to ensure that women everywhere, no matter their background, location, age, color of their skin, or even breast tissue type, can and should detect breast cancer early and improve their chances of survival.
The urgency of expanding early detection initiatives is clear, as breast cancer is now the most frequently diagnosed cancer globally. In 2020, there were over 2.3 million new breast cancer cases and approximately 685,000 deaths worldwide, making it the leading cause of cancer death in females. While early detection is crucial, it is still not widely accessible to over 90 per cent of the global women population. Mammography considered the “gold standard” for breast cancer detection, has been widely adopted in high-income countries like the United States, where over 39 million women undergo mammograms annually.
However, in low- and middle-income countries, particularly India, there is a stark disparity in mammogram screening rates. In fact, 99 per cent of eligible Indian women did not receive routine mammograms between 2019-2021. This gap in access has resulted in India having poor survival rate, with 98,337 deaths reported in 2022. Cost and access play a significant role in limiting these screenings. Furthermore, there are only 1.2 radiologists per 100,000 people, creating immense bottlenecks in diagnostic services. In rural areas, the situation worsens with limited access to healthcare infrastructure.
Despite the definition of mammography as the “gold standard” of care, it is crucial to note they are often not as effective as they need to be. Canadian data shows that mammograms fail to detect 30 per cent of not just all breast cancers but also the most lethal ones. American data shows half of all mammograms result in false alarms over just 5 screenings. And, for the nearly 50 per cent of women (in USA) who have dense breast tissue, it’s a double whammy – it means they are at a higher risk while mammograms are even less effective for them! USA invests USD18B for breast cancer screening every year, has the world’s best armamentarium of machines and an army experts, and yet 33 per cent of age-eligible women, who should receive a free mammogram, do not get it, take it or want it.
Being vigilant and finding your breast lump when you have no symptoms is the whole ball game. Unfortunately, we cannot dare to think like the USA, and implement mammography everywhere, because we inherently lack the basic infrastructure- experts, electricity, equipment and maintenance capital.
Furthermore, we have nowhere near the radiological expertise as required, nor the insistence from women to have a mammogram. Heck, I’ve been in this field for 16 years, and I couldn’t convince my mom to get a screening mammogram. Ceterus paribus, even if we could afford widespread mammography implementation, breast density limitations and high rate of false alarms would render it controversial, and eventually obsolete.
Remember the facts: we’re a country of 1.4 billion, with a tiny 1.7 per cent of our GDP dedicated to healthcare, and 85% of our population below 30. Breast cancer is the leading cancer in India, claiming 1 million productive life years annually, causing irreparable devastation in our families and communities, destruction that is largely avertable for most.
We have a clear and present solution: Clinical Breast Exams.
Recently, a 20 year running study published in the BMJ by the Tata Memorial Hospital, Mumbai, has demonstrated that Clinical Breast Exams, when performed by trained healthcare providers, can increase survival rates by 30%, particularly for women over the age of 50, while finding cancer at much earlier stages.
So what’s stopping CBE from reaching women across India? The challenge lies not only in a lack of awareness but also in the limited training of healthcare providers in administering and documenting CBEs. This form of screening, though proven effective, is subjective and requires specialized training that many health systems do not currently provide. The routine implementation of early detection initiatives for breast cancer cannot be won by individuals or institutions working in isolation. It requires a coordinated effort among academic institutions, government bodies, healthcare providers, and non-profit organizations to make Clinical Breast Exams (CBE) more accessible to most women.
This is the time for action. Randomized trials, like the one conducted by Tata Memorial, should inform policy and action, with national implementation. Initiatives like the Malabar Cancer Society’s outreach programs or YouWeCan’s partnership with the Goa government for the “Swasth Mahila, Swasth Goa” program exemplify how academic institutions and non-profits can work with public health systems and innovators to improve access to screening in both rural and urban areas.
Together, these groups can raise awareness about the importance of CBEs, innovate it further by tech-enabling it, and make early detection a practical possibility, a normal reality for women across India and the world. By working together, we can ensure that every woman has the opportunity, means and access to catch breast cancer early and increase her chances of survival. Don’t forget, majburi ka naam mahatma.
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