In Pune, breast cancer is most common regardless of gender: Dr C B Koppiker

As organisations and people across the world come together to raise awareness on World Cancer Day (February 4) and make cancer a global health priority, noted oncologist Dr C B Koppiker, also the founder of Prashanti Cancer Care Mission, talks to The Indian Express about the most common forms of the disease, how awareness can help in early detection and the government’s approach to reduce cost of treatment

What is the data on cancer in India and Pune?

The latest WHO-GLOBOCAN data came out in October 2018. In India, approximately 11.57 lakh new cancer cases are detected per annum with 7.84 lakh deaths. India has the dubious distinction of having one of the highest cancer-associated mortality rates in the world. Data specific to Pune is not available in detail. However, according to the Pune Cancer Registry (a clinic-based registry), breast cancer is the most common type, regardless of gender.

Have attempts to raise awareness led to a rise in the detection of cases. Which is the most affected age group?

Early detection remains the key strategy to counter cancer incidence and mortality. However, a lack of awareness among women about symptoms, screening modalities, breast self-examination (BSE) and/or routine mammographic screening leads to negligence, resulting in a delay in diagnosis and treatment. However, at Prashanti Cancer Care Mission, several camps conducted for early detection have seen a rise in women keen to know more about the disease. The median age at first diagnosis of breast cancer in India is between 40 and 45. This is starkly different than the western population in which women get affected with breast cancer around mid-fifties. In India, many young and premenopausal women are affected whereas in the west, middle-aged, peri- or post-menopausal women get most affected.

Which is the most common cancer in India among men and women?

The top five types that affect Indian population are breast (14 per cent), oral (10.4 per cent), cervix uteri (8.4 per cent), lung (six per cent) and stomach (five per cent), of all cases. As of 2011, prostate cancer was the most common form among males (about 28 per cent of all new cases) and breast cancer was the most common in females (also about 20 per cent of all new cases). The leading cause of death in both males and females is lung cancer, contributing to 26.8 per cent of all cancer-related deaths.

Apart from preventive aspects, are there new treatment modalities?

Chemotherapy and radiation therapy are still part of the cancer clinical management drill. Both modalities also now focus on preserving the quality of life of the patients. Oncoplastic surgery, where breasts are saved in a manner that the aesthetics of the breast are improved, is becoming popular. Targetted therapeutic options are available in some variants of the disease; molecular oncology-based tests are becoming mainstream that allow tailor-made therapies based on the so-called personalised medicine approach. The high cost is a barrier.

Has the government helped in reducing cost of treatment?

Overall, several efforts have been made to bring down the cost of cancer treatment by reducing the cost of life-saving drugs. The government has floated patient-friendly policies where patients can avail the social-impact schemes to treat the diseases. Public private partnerships have been set up and national awareness and screening programmes for common cancers are expected to have an impact.

At Prashanti, several efforts have been undertaken to help prevent cancer. What are the future plans?

About 400 prevention awareness programmes were held last year. We have set up buses equipped with mammography machine and around 6,500 women were screened and six cases detected that demonstrates the impact of community screening. An MCH programme in oncoplastic surgery has been set up where breast surgeons across India and Southeast Asia are being trained. At the newly set up Centre for Translational Cancer Research (CTCR – a joint initiative between Prashanti and IISER Pune), oncologists and molecular biologists are collaborating to gain new insights into breast cancer biology in the context of Indian population.