Women And Cancer: Forewarned Is Forearmed

As an oncologist, the first thing that comes to my mind is the tremendous physical and emotional toll that cancer can take on women sufferers. Some of that suffering can be alleviated with greater knowledge and awareness of the different kinds of cancer that affect Indian women today.

When uttered together, the words ‘cancer’ and ‘women’, invariably evoke the specter of that much-dreaded cancer: breast cancer. Not only is it a physical concern, it is also a deeply emotional one. A woman’s body image, self-perception, and her very identity are often centered on her breasts and can be shaken by such a diagnosis.

Breast Cancer

Breast cancer is a cancer that is most likely to affect urban Indian women, and is the most prevalent malignancy among women worldwide. While the incidence of breast cancer has soared over the past few decades, breast cancer mortality has, fortunately, decreased overall- mostly as a result of better treatment and early diagnosis. Every 1 in 8 women has a risk of developing breast cancer in their lifetime. Overall, breast cancer affects about 30 to 35 out of one lakh Indian women each year, with the risk of incidence increasing with age.

Risk factors

The majority of breast cancers (90 per cent) are sporadic or random, which means there is no definite cause. There are numerous breast cancer risk factors such as family history, age, female gender, early menarche (onset of periods), late menopause, childbirth after the age of 35, lack of breast feeding, prolonged hormone replacement therapy (HRT), obesity, benign proliferative breast disease, lack of physical exercise and alcohol consumption to name a few. Genetic mutations such as BRCA 1 and 2 are related to 10 per cent of breast cancers

Symptoms: The most common presentation is a lump in the breast. It is usually painless and persists throughout the menstrual cycle. Pain is associated with only 2-7 per cent of breast cancers. Patients also experience skin puckering/dimpling/ulceration. Nipple discharge or lump in the armpit.

Breast cancer screening

The good news is that if diagnosed at an early stage and properly treated by trained professionals at standard centers, more than 90 per cent of early stage and up to 40-50 per cent of locally advanced cancers (restricted to a specific region) can be cured. So, what is most essential in India is awareness and screening. The screening recommendations are based on individual risk factors but as a thumb rule, for women without a significant family history, annual mammograms are strongly recommended from age 40 onwards. In India, most cancers are diagnosed in late stages due to lack of awareness and screening, in contrast to West where effective screening results in most cancers being diagnosed in early , highly curable stages. Also, every woman should have a clinical breast examination, conducted by a trained clinician, once every year starting at age 40. Having seen so many young women afflicted with the disease, commencing clinical breast examinations at the age of 25 and conducting them once every one to three years is a also a highly advisable move. All women must learn to perform breast self-exams and should do so once every month. Easy to do and free of cost, this is a priceless procedure that poor and working-class women who cannot afford expensive check-ups, or lack easy access to specialized healthcare facilities, can benefit from. The point of early diagnosis and screening can help save a woman’s life, as well as her self- image since breast conservation surgery, is only possible in the early stages. Yearly mammogram after 40 reduces the mortality from breast cancer by almost 25percent

Cervical Cancer

Cervical cancer is a major worldwide health problem in women. It is the fourth most common cancer among women worldwide, with 85 per cent of such cases occurring in developing countries like India, where rural women are most likely to be affected. Due to a lack of awareness and education, and widespread social stigma, women tend to avoid seeking medical help until it’s much too late thus losing their lives to a highly preventable, and curable, form of cancer.

Risk factors

Unlike other cancers, we know that the primary cause of cervical cancer, especially in high prevalence developing countries is the persistent presence of the human papillomavirus (HPV). HPV is a sexually transmitted virus. HPV mostly types 16 and 18 is associated with cervical cancer.

Risk factors for cervical cancer include a lack of hygiene, early marriage and childbirth, multiple sexual partners (especially when the sex is unprotected), multiple childbirths, smoking, presence of sexually transmitted disease (STDs), and chronic immunosuppression due to infections such as HIV.

Symptoms: The most common presenting symptom is vaginal bleeding, especially post-coital bleeding. There can also be foul-smelling vaginal discharge, backache, urinary problems and in late stages patient can even have kidney failure.

Preventing cervical cancer

Today, we have vaccines to prevent these infections thus dramatically reducing the incidence of cervix cancer. To a great extent, annual pap smears and routine checkups by a gynecologist are

all that is needed to prevent this ghastly disease. The reason for the decline in cervical cancer in affluent countries is because of effective screening protocols. But a word of caution: women who have been vaccinated must also continue with annual pap smears as the vaccines cannot provide protection from all strains of the HPV. An effective treatment that combines surgery, chemotherapy, and radiotherapy, can cure almost 80 per cent of women with early-stage diseases, and 50-60 per cent of women with stage 3 (locally advanced) diseases.

Together, we can

Finally, what we need most is social support. I have treated many women and have even cured some of them. What I have not managed to do is change prevailing attitudes towards cancer. Many of my patients have been deserted by their husbands and their families, all because they have cancer!!! This is an outrage in this day and age. These women need support, not only medical and financial but also social. Support groups for patients and family members would be a very welcome move. Spread light, not darkness!

Also, let us pledge on this World Cancer Day that those of us who can afford to, will initiate cancer screenings (for breast and cervical cancer) according to recommended guidelines, for at least one special woman in our lives from this year onwards, be it our mother, sister, wife or daughter. Let us also do our best to spread as much awareness as possible among less fortunate women about cancer and how to prevent it.

Dr Kakoli Lahkar

Guest Author The author is Consultant – Medical Oncology, Manipal Hospitals