Breast conservation surgery a boon to cancer patients

Breast cancer, for long considered to afflict older women in cities, is casting its long shadow over the length and breadth of India. The disease has grown by more than 250% in just a decade, and is now spreading not only across the rural-urban divide, but also among younger women. 

More than 1.3 lakh fresh cases of breast cancer get reported every year in the country now, up from 54,000 ten years ago. It has emerged as the most common form of cancer in cities, and the second most common in rural areas. In fact, the disease accounts for more than one-fourth of all cancer cases in Indian women, and is the fifth most important cause of cancer-related deaths. 

A study conducted by The Pink Initiative (breastcancerindia.net), a NGO, has revealed a significant shift in the age group of breast cancer patients in the country. About 25 years ago, out of every 100 breast cancer patients, two fell in the 2030 age group, seven in 30-40, and 69 were above 50 years of age. Today, four patients are in the 20-30 age group, 16 in 3040, and 28 in 40-50.

In other words, almost half of all breast cancer patients are now below the age of 50. Additionally, an increasing number of patients are between 25-40 years of age, which is very disturbing. Breast cancer if detected in time and treated adequately is curable. Digital mammography is a special type of X-ray examination of which detects cancer in very early stages. 

Every woman who turns 40 should get it done once a year. Surgery for breast cancer has come a long way since radical mastectomy (complete removal of breast) was first prescribed. The most common surgery for breast cancer today is modified radical mastectomy (MRM), which entails complete removal of the breast with or without reconstruction. The other option is breast conservation surgery (BCS), which involves removal of only the tumour, leaving the rest of the breast intact. Breast conservation treatment (BCT) comprises BCS and whole breast radiotherapy, with recurrence rates and overall survival rates comparable to MRM. BCT has now become the standard of care for early breast cancer in the West.

At Meenakshi Mission Hospital, we conducted a study some years ago involving breast cancer patients who were on follow-up after surgery. The aim was to assess their quality of life after breast removal. The study threw up some startling facts. Almost one in three patients said she was being neglected by her spouse. 

In fact, many of these women had been abandoned by their husbands, probably because men couldn’t reconcile to breast removal of their wives, even if they had supported the decision initially. About 38% of the patients reported a negative impact on their attitude towards sex, while 73% said breast removal negatively affected their body image. Most breast cancer patients, their spouses and relatives take a decision in favour of complete breast removal even when the disease is in early stages and curable, 

due to fear and the false notion that the cancer will not grow back if the entire organ is removed. 

These patients need to be educated to opt for breast conservation treatment to avoid harming their quality of life later, as we found in our study. Unfortunately, in India, BCT is not popular with doctors or patients. Only 11-23% surgeons prefer it, compared to 60-70% in the West. The advantages of BCS over MRM include better body image, sexual function and psychological adjustment.