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COVER
STORY: HEALTH
The
New Threat
Breast
cancer is rapidly emerging as the most common form of cancer among urban
Indian women. Among the suspects are a range of lifestyle changes including
late marriages and increased alcohol consumption. Fortunately, new treatments
bring hope in an area of despair.
By
Farah Baria
They
were your average millennium yuppies. He was a securities banker, she
worked as an accounts executive in a Mumbai advertising agency. Their
day was mechanically programmed: wake up at 7 a.m. in a matchbox suburban
apartment, crawl into town through peak-hour traffic, deal with clients
over endless cups of coffee and grab a Coke and sandwich for lunch. Then,
when the day is done, meet with friends at a pub to unwind over greasy
tandoori chicken and a couple of vodkas, and crawl back again to their
cubbyhole. Life was tough. But the money was good, marriage was okay and
babies were definitely not on the personal projects page of this year's
planner.
 Then
one day in April this year, 32-year-old Anita Desai found a small hard
nodule on her left breast, just under the armpit. A biopsy showed it was
malignant. "Our lives came to a grinding halt," she whispers
softly. After the chilling discovery followed weeks of grim chemotherapy,
trauma and, above all, bewilderment. "I thought breast cancer only
happened to older women," she says. "Besides, my family had
no history of the disease." Now Desai can ask only one question:
"Why me?"
At the Tata
Memorial Hospital and Research Institute (TMHRI) in Mumbai, the largest
cancer research centre in the country, Dr Indraneel Mittra tersely provides
the answer: female emancipation. It is not a sexist pronouncement or even
a conservative verdict. Just a neutral assessment of neutral statistics.
Breast cancer
is rapidly catching up with cervical cancer as the most common type of
cancer among urban Indian women. According to data compiled by the Delhi-based
Indian Council of Medical Research (ICMR), in Delhi and Mumbai breast
cancer is already the No. 1 form of cancer among women. In Bangalore and
Chennai, cervical cancer still leads, though the incidence of breast cancer
is on the rise. While increasing hygiene and improved healthcare facilities
have helped control the viral infections that lead to cervical cancer,
changing urban lifestyles are believed to be behind the rise in the incidence
of breast cancer.
The medical
community is slowly waking up to this grim fact. "Till now we were
more concerned about cancer of the cervix. It is only in the past few
years that we have begun research on breast cancer," says Dr Bela
Shah, head of the non-communicable diseases division of ICMR. According
to Dr B.B. Yeole, an epidemiologist at the Indian Cancer Society, every
year 80,000 new cases of breast cancer are detected in Indian cities.
The disease claims 35,000 lives every year, up by 18 per cent since 1990.
While statistics
like these may sound negligible, the reality is not. In 1970, for instance,
the incidence of breast cancer in India was barely 20 per 1,00,000 urban
women. Today, that number has shot up to 28.6, nearly a 50 per cent jump.
Among the Parsis in Mumbai, a relatively westernised community in which
few women have children and fewer breast feed them, the incidence rate
is higher at 43.8 per 1,00,000 women. Comparatively, in rural areas the
incidence is only 8.5. This is still far less than the West, where one
out of nine women gets the disease.
But urban
India is not far behind. Dr K.A. Dinshaw, head of the TMHRI which deals
with a hopeless tide of cases from all over India, says the incidence
of breast cancer is likely to double in the next 10 years. In fact, cancer
experts like Dr Sameer Kaul at the Indraprastha Apollo Hospital in Delhi
believe that one of every 20 women in Mumbai and Delhi is likely to develop
breast cancer. This, says Dr Yeole, is only the tip of the iceberg because
most breast cancer cases still go unreported.
Worse, the
patients are getting younger. "Unlike a decade ago, women in their
20s and 30s are also developing malignant tumours," says Mumbai-based
epidemiologist Dr Perin Notani. But this could also be due to an increased
awareness of the disease. With more and more women-especially younger,
informed individuals-going in for breast examinations, the number of cases
detected has gone up while the average age has come down. Interestingly,
as Dr V. Shanta, executive chairman of the charitable Cancer Institute
in Chennai, points out, almost two-thirds of breast cancer patients belong
to the upper class.
The underlying
cause, ironically, is the rapid modernisation of Indian society. For instance,
Dr B. Rajan, professor of clinical oncology at the Regional Cancer Centre
in Thiruvananthapuram, attributes the rise in breast cancer cases in fully-literate
Kerala to the high level of education among women which means they marry
late, have fewer children and breast feed them for only a couple of months
before returning to their jobs.
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The
Indian industry has increased its decibel level of whining. Instead, it
should get the government to deliver, says INDIA TODAY Associate Editor
V. Shankar Aiyar in 