Keeping abreast of the rising danger

CHENNAI: It was November, four years ago. A burning sensation in my right breast and a string of painful nights led me to have a conversation with Radha amma, at whose house I was working as a maid,” narrates 40-year-old Selvi Kumaresan, recalling how opening up to her employer about her discomfort helped in detecting the incidence of breast cancer before it could escalate to an advanced stage.

“When I talked about the pain, I could see her forehead creasing with concern. Immediately, she called up her friend who’s a doctor and scheduled a cancer screening. The doctor noticed a dimple near my nipple and this was followed by a mammogram and a biopsy. In a few weeks, I was diagnosed with second stage breast cancer. Since then, visits to doctors, meeting surgeons and chemotherapy became the norm.

While sadness and uncertainties perpetually washed over me, I was grateful for one thing — for the early intervention I received. Had Radha amma not made that detection and phone call that day, I, perhaps, wouldn’t be talking today,” says Selvi, a resident of Choolaimedu. “I am now part of a local self-help group and over the last two years, I have taken it upon myself to spread awareness about breast cancer among women in low-income groups. Many aren’t aware of the disease.

Early detection and intervention are very important,” she offers. According to data from a first-of-its-kind report compiled by the Adyar Cancer Institute and the State Health Department, the incidence of breast cancer among women in Chennai has seen a significant rise. “Contributing factors for breast cancer are aplenty. Rampant lifestyle and dietary changes and the change in the reproductive profile of women in the last two-odd decades are some.

Breast cancer incidence in Chennai is 53 per one lakh women, making it the highest in India,” notes R Swaminathan, assistant director of Adyar Cancer Institute, adding that the cases in Chennai (per lakh women) are increasing by 2%. Concurring, Dr AC Senthil Kumar, a surgical oncologist, points to more people moving towards a ‘westernised’ lifestyle as one of the many causes for such lifestyle-oriented diseases. “With reproductive history recognised to affect the risk of breast cancer in women, a more risk-adapted breast cancer screening and personalised screening should be made more available.

And it is not only the urban population that is being threatened by the burden of breast cancer; the numbers are catching up in rural regions too. However, with more awareness being created around the disease, the detection rates are certainly increasing,” he says.

Early detection
Saranya Venkatesh, a cancer survivor and co-founder of Kope4cancer, a social initiative, which aims to help and support those with cancer and create awareness around it, shares that advancements in the medical industry, continuous clinical trials and varied treatment options, have enabled around 90 per cent of breast cancer cases to be cured if detected early.

“The key is early detection,” she says, reiterating the thread of thought sounded by experts and survivors. “The road to early detection lies in regular master checkups, self-breast examinations (SBE), mammogram for women above 30 and visiting a doctor for minor abnormalities.

Also, women should not feel embarrassed to talk about this to their family, friends or even visit a doctor to get it checked. Cancer has evolved to become a lifestyle disease that needs conscious efforts to be controlled. For women with a family history of cancer, it’s advised to go for genetic counselling to understand if they carry BRCA1 and BRCA2 mutated genes to assess the possibility of them getting cancer,” she details.

Nutritional balance
Despite the lack of magic bullets or corrective therapy to completely attenuate incidence, spread, and relapse of breast cancer, nutritional balance and lifestyle choices can greatly aid in prevention and recuperation, shares Senthil Kumar Balu, a cancer researcher-cum- home baker at Wholesome Rhapsody.

“The lifestyle-associated risk factors for female breast cancer include overweight and dense breast tissue, obesity after menopause (Obese women have higher circulating estrogen and insulin which is linked with the development of postmenopausal breast cancer), sedentary lifestyle and alcohol consumption.

A balanced intake of unpolished whole grains, unrefined unsaturated fat, dietary fibre (from grains nuts vegetables, and fruits,) lean protein, other essential micronutrients and exercise for women of all ages, especially those above 50, can greatly help in breast cancer prevention,” he explains.

For a breast cancer patient undergoing therapy, or as a part of a recuperative diet, additional intake of plant-based phytonutrients such as curcumin from turmeric, EGCG from green tea, lignans from sesame seed/oil, flaxseed, allicin from crushed garlic, and a plethora of others, can help in maintaining a balanced diet and for the effective functioning of bodily repair mechanisms, he adds.

Insurance schemes
Cancer treatments can be a prolonged affair and its high costs often warrant proper planning. But, lack of awareness of existing health schemes can add to the misery. “Cancer is known as a rich man’s disease. There’s not much awareness on health policies available in the market and at the time of diagnosis, financial stress is the last thing one should be going through. The only answer to get rid of this is to have proper health insurance in place,” says Saranya.

With Star Health Insurance Company Limited’s Star Cancer Care Gold, HDFC ERGO Health Insurance Company Limited’s iCan cancer insurance, Aditya Birla Sun Life Insurance Company’s ABSLI Cancer Shield, ICICI Pru Heart/Cancer Protect, HDFC Cancer Care to The New India Assurance Company Limited’s Cancer Guard offering specialised benefit policies and indemnity policies for expenses related to cancer treatment at multiple stages of the disease, investing in one from an early stage can be beneficial. The government’s Chief Minister’s Comprehensive Health Insurance Scheme too has benefitted many, points out K Senthil Raj, mission director of National Health Mission (Tamil Nadu).

NCD clinics
With the health scene evolving, he says that the focus of healthcare has now shifted from communicable diseases to non-communicable diseases. “Since we have been able to contain communicable diseases, the lifespan of individuals has increased and the infections are controlled. Now, we are coming up with more investigating mechanisms to find non-communicable diseases and their incidences including that of breast cancer,” he shares.

In the country, non-communicable diseases (NCD) like cardiovascular diseases, cancer, diabetes and other chronic respiratory diseases account for about 60 per cent of all diseases. The government of India, since 2010, has been implementing the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) up to the district level under the National Health Mission. “Under this, NCD clinics throughout Tamil Nadu have been set up and a staff nurse has been appointed in each clinic.

The objective is to promote health, conduct screening at all levels in the health care delivery centre from sub-centre and above for early detection of diseases including breast cancer and to build capacity at various levels of healthcare for prevention, early diagnosis and treatment and rehabilitation. With increasing incidence of breast cancer, one of the key focus areas has been in screening and early detection, which improves the survival and success rate multifold,” he explains.

Under the Ayushman Bharat Yojana, Senthil says, the government of India is setting a target to set up more health and wellness centres in sub-centres. “Every 385 block in the state have been receiving universal health coverage. More health and wellness centres will be set up to ensure detection, treatment and follow-ups. Also, to mobilise those from the rural areas to get timely screening and early detection of cancer and other NCDs, Panchayat Level Federations — federations formed by women self-help groups — have been set up in all the 12,600-odd villages in the state.

Every federation has a nominated member, who will also act as a health volunteer. They are trained in fieldwork and provided with required test kits. Patient support groups with around 25 members in each group, in panchayat levels, have also been formed. This way, we won’t be missing out on any incidence of diseases and be providing timely treatment.

With a rise in telemedicine, especially during the pandemic, we are also planning to focus on developing tele oncology in the state,” he shares. “Chemo centres have been established in district hospitals in an urban scope model, connecting district and subdistrict hospitals with medical colleges. This way, patients in rural areas can take chemotherapy in sub-districts, and once in three cycles visit medical colleges to ensure things are on track,” he says.

Self-breast examination

1. What?
It is a tool where one can examine themselves to help identify any changes in the breast so that they can pick up any disease of the breast at the earliest stage possible.
2. Where?
It can be done at home, just before you get into the shower (standing position) or in a lying down position on the bed.
3. Who?
Everyone over the age of 25
Anyone with a family history of cancer/breast cancer can start earlier - between 20 and 25 years of age
4. When ?
Two to three days after your period or choose any one day of the month; to be done only once a month if you don’t get your period.