Why more young women in India are getting breast cancer

Popular TV actor Hina Khan recently said she had been diagnosed with stage three breast cancer. Sharing the news on social media, she said she was "doing well" and was "fully committed to overcoming this disease". Khan, who said her treatment has already begun, is known for her roles in TV serials Yeh Rishta Kya Kehlata Hai and Kasautii Zindagii Kay. She was also the runner-up on Bigg Boss 11.Once considered a disease of older women, breast cancer is afflicting the likes of younger women like Khan, who is just 36. Oncologists say they are seeing an increase in the cases of women in their early 30s getting diagnosed with this ailment. medium111363052In August, 33-year-old Andheri resident Riya Sonawane (name changed) noticed a small lump in her left breast. Two months later when she realised that the tumour was getting bigger, she consulted her aunt who is a staff nurse at Wockhardt Hospital in Agripada, Mumbai. The latter told her to get it examined, asking her not to worry much.In October, Sonawane got herself examined by senior oncologist Dr Meghal Sanghavi at Wockhardt. The doctor told Sonawane that the tumour could be benign given her young age and the fact that she has no family history of cancer. However, she recommended a mammography and a biopsy to confirm the diagnosis.A week later when the test results arrived, Sonawane was diagnosed with Stage 3 breast cancer, which means her cancer had spread from the breast to the lymph nodes, to the skin of the breast or to the chest wall.The revelation came as a big shock for Sonawane; she thought her career and marriage plans were completely shattered. But Dr Sanghavi counselled her that she would get cured if she followed the right treatment and once the treatment was over, she could live a better life.medium106380866Major studiesA team of 24 doctors from Tata Memorial Hospital, Mumbai, published a paper titled ‘Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India’ in October 2021, which talks about a significant rise in young women getting the disease.A total of 8,634 breast cancer patients were registered with the hospital between January 2015 and December 2016. Of them, 1,228 in the age bracket of 25-40 years with a median age of 36 years were included in the study.According to the paper published in the ScienceDirect medical journal, the majority (86.9%) had Grade 3 breast cancer (faster growing cancer that’s more likely to spread). medium106380882Another study by the Madras Metropolitan Tumour Registry at the Cancer Institute in Adyar showed a 7% increase in the incidence rate of breast cancer in the past 15 years. Among the women between 25 and 40 years of age, the registry reported a 1.5% annual increase in the incidence of breast cancer.In October, Apollo Hospitals released data which showed an increasing trend of breast cancer among young women. Analysing close to 1.5 lakh screenings over the past five years, Apollo found that more than 25% of breast cancer diagnoses were in women less than 40 years of age. The findings are based on data collected between 2018 and 2023.Similarly, data released by AIIMS Delhi in August showed that 30% of breast cancer cases were found in women below the age of 40 years. The data analysed was from 2015 to 2022.All these studies highlight a critical need for increasing awareness and early intervention through screening and diagnosis among Indian women.What experts sayWhile researchers are trying to pinpoint the actual reason behind this trend, factors including genetic predisposition, delayed childbirth, infertility treatment, sedentary lifestyle, unhealthy eating habits, smoking, drinking alcohol, stress and air pollution could cause breast cancer, experts say.The experts have also raised concern that younger women with breast cancer often experience higher emotional distress than older women. In its study, Tata Memorial Centre concluded that “chemotherapy can accelerate menopause by a decade and there is a 70% lower chance of conception post breast cancer therapy compared to women of the same age”.“The proportion of young breast cancer appears to be higher in India and represent a distinct subgroup. It is alarming to note that even in the current era, more than half of the patients present at an advanced stage, which calls for an escalation of cancer awareness and screening programmes in this group,” says Dr Sudeep Gupta, director, Tata Memorial Centre.The unique problems of young breast cancer patients, like fertility preservation and quality of life issues, need to be addressed appropriately and the data recorded prospectively in future studies, he opines. medium106380919Delayed diagnosis is another issue that needs to be addressed urgently, the oncologists say.“The misconception that cancer is an improbable cause of health issues in younger age groups often results in delayed diagnoses, potentially leading to missed opportunities for early intervention, better outcomes and survival rates,” says Dr Sathya Sriram, chief executive officer (preventive health), Apollo Healthcare.“I urge women across the nation to prioritise timely screenings and also encourage physicians to personalise their recommendation to patients, especially if they have a family history of cancer,” says Dr Sriram.According to Dr Sanghavi of Wockhardt, despite awareness in urban areas, there has been an increase of breast cancer cases in cities.“It is seen that younger women with family history do not go for screening. In western countries, all employees have to undergo mammography annually after the age of 30 to 40 years. Very few women in our country go for these screening after the age of 35 or 40 years where the pickup rate is delayed,” she says.“So, it is always recommended that every woman from the age of 30 should start self-breast examination one week after their period and make this a regular practice since it is cost-effective and can be done at home,” she says. medium106380950She also flags certain risk factors such as too much stress, sleep disorders, hectic lifestyle, fertility treatment, long-term hormone therapies among others.“Long-term hormone therapy is a risk factor for breast cancer. Anything where the natural process is bypassed, there will be alterations. So, the disease which comes in younger women is more aggressive and there are more hormone negative tumours, which means that the quality of cancer is bad. Last but not least is ignorance,” Dr Sanghavi adds.Early menopause, late menopause, obesity, lack of physical activity and exposure to environmental toxins (pollution) for a longer period of time at a young age may be linked to the rising cases of breast cancer, says Dr Tejal Khadakban, surgical oncologist at Onco Life Cancer Centre, Pune.In a recent interview to TOI+, Dr Arvind Kumar, chairman of the Institute of Chest Surgery-Chest Onco-surgery and Lung Transplantation at Medanta Hospital, Gurugram, referred to air pollution in cities like New Delhi as a likely cause of breast cancer.“An average adult breathes 25,000 times a day and we take in about 11,000 litres of air every 24 hours. So, given the amount of toxins in the air, a non-smoker breathing in air with an AQI [Air Quality Index] of above 500 is akin to smoking 25-30 cigarettes a day,” he says.“Small amounts of toxins and dust in the air, which get deposited in the lungs, turn into huge deposits of unwanted chemicals that eventually spread throughout the body. If smoking causes cancer then I would definitely say that young women getting breast cancer could be linked to bad AQI levels, especially in Delhi,” he adds.