BREAST CANCER CASES SHOOT UP IN KERALA

BREAST CANCER CASES 

SHOOT UP IN KERALA

Capital records highest crude incidence rate in country

            Breast cancer incidence has been shooting up in the State and Thiruvananthapuram has emerged as the nation’s breast cancer capital, recording the highest crude incidence rate of 40 (per 1,00,000 women), as per the latest estimation (2012) of the Population-Based Cancer Registry for Thiruvananthapuram at the Regional Cancer Centre (RCC) here.

If the crude incidence rate in Thiruvananthapuram urban area alone was considered, it could be well over 42 per 1,00,000 women, it is estimated.Breast cancer constitutes about 28-30 per cent of all cancers at the RCC. Going by RCC’s treatment records (hospital registry), about 50 per cent of the breast cancer cases are occurring in those less than 50 years of age.

Incidence rate indicates the number of new cases in a population annually. The breast cancer incidence rate in other urban centres in the country ranges from 18 to 36 per 1,00,000 women.

The incidence rate of 40 per 1,00,000 women is the crude incidence or actual incidence rate in the population. But even after calculating the age-adjusted incidence rate (incidence of breast cancer adjusted for differences in age distribution and hence, a fairer comparison), Thiruvananthapuram would still have the highest breast cancer incidence in the country. The crude incidence rate last year had been 36 per one lakh.

Actual incidence

Epidemiologists point out that while the actual cancer incidence has definitely gone up, the improvement in the methodology applied in data management could also be reflected in the statistics. There are 27 population-based cancer registries (PBCRs) in the country under the National Network of Cancer Registry set up by the Indian Council of Medical Research, two of which – Thiruvananthapuram and Kollam – are in Kerala. There is also the hospital-based cancer registry of RCC, which gives a picture of the number of cancer cases, disease and survival patterns in the State, based on the number of cancer cases which gets treated at RCC.

Cases at RCC

RCC is estimated to handle about one-third of all cancer cases happening in Kerala. If a decade earlier, the average annual incidence of cancers in Kerala was 100 per one lakh population, the 2012 data indicates that the incidence rate has climbed to 150 per one lakh population

However, there is no single PBCR for Kerala, collating data from across the State and hence there are no accurate statistics for cancer incidence or mortality in the State.    

Global phenomenon

The rising incidence of breast cancer is a global phenomenon, with incidence rates varying from 19.3 per one lakh women in Eastern Africa to 89.7 in Western Europe.

“But breast cancer mortality rates have been plummeting in the West, with excellent five-year survival rates (the number of people who survive five years after being diagnosed with cancer).We have to be concerned because our mortality rates are quite high. This is because the proportion of breast cancer cases detected early here are much lower than early detected cases is much lower than that in the West ,” says Aleyamma Mathew, Additional Professor, Cancer  Epidemiology, RCC. 

Approximately 80 per cent of the breast cancer cases coming to RCC are seen in people in the 35-64 year age group.

According to WHO, while some risk reduction might be possible, there are no effective strategies to eliminate breast cancer. It advocates regular clinical examination of the breast by a doctor or nurse so that early detection, better outcome and survival is possible. Women at high risk, based on certain factors like family history or risk of mutation in certain genes, should get an MRI and a mammogram every year.

Diagnosis

At the community level, health workers can be trained in proper breast examination using a prosthetic breast and engaged  as part of the State’s Campaign Against Cancer to create awareness among women on breast cancer and to encourage them undergo clinical examination regularly, Dr. Mathew said.

Cancer should be made a notifiable disease as it has emerged as a major non-communicable disease and a public health problem in the country, oncologists have pointed out.

It is imperative that the State Government takes such an initiative and sets up a single State-level population-based cancer registry so that there is an accurate estimate of the magnitude of cancer as a public health problem in the State. This will also helps researchers monitor the variation in cancer incidence over time by site, stage at diagnosis, patient management and survival.

·  Thiruvananthapuram recorded crude incidence rate of 40 per 1,00,000 women

·  Breast cancer constitutes about 28-30 per cent of all cancers at the RCC

Prof. John Kurakar