By Dr R A Badwe Director-Tata Memorial Centre
Early detection is the best way to deal with cancer and research is showing changing trends in the occurrence of cancer in women in India
Cancer in women evokes two kinds of responses – the first is fear which is a justifiable patient’s perspective and the second an optimistic awes which is a medical viewpoint, but we will get to that later. First, let’s take the fear head on. The commonest cancers affecting women in India are breast, cervical cancer and head & neck cancers related to tobacco. All the three cancers lend themselves to early detection easily and if detected in stages I or II are immensely curable with more than 70-80 per cent chance of reaching full life expectancy of 75 and above.

Breast cancer
Breast cancer is on the rise in cities and midsize towns where late first childbirth, shortened duration of breast feeding and obesity contribute as important causative factors. This urban lifestyle (reproductive as well as dietary) has produced a stark difference in the rural incidence of 8 per 100000 women per year to 30 per/100000/year in cities compared to more than 150/100000/year in US.

Cervical cancer
Fortunately this rise is offset by a dramatic reduction in uterine cervical cancer of almost the same magnitude. Uterine cervical cancer incidence is high in rural India but is on the wane in cities. It is important to note that this reduction has happened without widespread screening or vaccination.

How societal factors play a part in prevention
The major reasons are improved genital hygiene in men and women, use of barrier contraception and male circumcision. In cities where running water and the privacy of bathroom is often available; improvement in genital hygiene is a natural consequence, whereas in rural India the lack of such facilities and awareness about cleanliness has continued to contribute to the problem.
The religious practice of circumcision in males early in life in some Middle Eastern countries as well as in Israel has resulted in an extremely low incidence of uterine cervical cancer in these areas. The incidence of uterine cervical cancer in some religious communities in India that adopt the same practice is half compared to others. Wider adoption of male circumcision will prevent many cervical cancers.

Early detection is vital
Uterine cervical cancer screening with visual inspection or PAP smear is life saving and should be sought by every woman after the age of 35 years. Vaccination has shown a reduction in precancerous lesions in cervix but the evidence to reduce true invasive cancers and saving of lives is not yet available.
Screening for breast cancer is required after 40 years of age in all women with clinical breast examination performed by a trained breast cancer screening specialist/nurse/health worker. Mammography can be used judiciously in women above the age of 50 years in conjunction with clinical breast examination. Breast self examination by women themselves, a monthly exercise is an excellent tool for awareness but should be practiced by women who have fully understood what they are looking for and they are willing to do it as there is thin line between awareness and anxiety.

Prevention is better than cure
Obesity is a preventable modern affliction that leads to increased risk of breast, uterine, colon and stomach cancers, and other killers like diabetes, hypertension and coronary heart disease. So ‘Sub Dukhon Ki Ek Dava’, is attainment of ideal body weight and preventing all these ailments. Brisk walk of 30-45 min every day, no elevator up to three floors and small dinner are some easy to implement tips to lose or maintain body weight.

Let us now turn to the medical viewpoint of ‘Optimistic Awe’. Women in general have a much better cure rate after treatment of many cancers e.g. colon, head and neck, thyroid, and breast. We at the Tata Memorial Hospital are conducting research to find out which factors lead to better cure rates in women. In breast cancer, our research has shown a 30 per cent relative reduction in recurrence using natural progesterone as a single injection prior to surgery. For men, it is a matter of concern as to why many more should die when afflicted by cancer.


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