With some 165,000 new cases being diagnosed every year, the incidence of breast cancer has overtaken cervical cancer to become the most common cancer affecting women in India. What is even more alarming is that breast cancer is being increasingly diagnosed at a younger age (a decade earlier) in India, compared to the West. Due to lack of awareness and absence of an organised nationwide population-based breast cancer screening programme, more than 70 per cent of breast cancer in India is present in advanced stages, and as a consequence, majority succumb to the disease within a year of being diagnosed. With 87,000 deaths per annum, tragically, a woman loses her life to breast cancer every 10 minutes in India.
In 2002, whilst working in United Kingdom, my mother, Dr. Ushalakshmi was diagnosed with breast cancer. Her unexpected diagnosis coupled with a mission to work alongside like-minded colleagues to improve the delivery of breast healthcare in India became the defining moment in my life. The aim of this article is to share some of my goals that I translated to reality over the past 12 years, since relocating to India.
The ‘Breast Centre’ concept
Breast Surgery is now recognised as a subspecialty of General Surgery in the West with structured training for designated ‘Breast Surgeons’. There are recognised training Programmes in Oncoplastic Breast Surgery abroad and over the years, breast cancer care has been enhanced by the emergence of Specialist Breast Surgeon with training in Oncoplastic Surgical skills – Oncoplastic Breast Surgeon. Equally, there is robust evidence from literature to suggest that outcome of patients with benign breast disease and indeed breast cancer is best when they are managed by well-trained dedicated breast specialists within the confines of ‘Breast Centres’.
Mirrored upon the world’s first breast centre that was established in California, in 2007, I conceived, designed and established KIMS–USHALAKSHMI Centre for Breast Diseases, South Asia’s first free standing, purpose built comprehensive Breast Health Centre, which is located in Hyderabad, the capital city of the southern Indian state of Telangana. As nine out of 10 breast health issues are benign, the aim is to reassure the vast majority of “worried well” and treat those diagnosed with breast cancer in a multidisciplinary environment.
Breast Cancer foundation
Having identified lack of awareness as one of the main reasons behind high mortality for Breast Cancer in India, a ‘not for profit’ breast cancer Charity was founded during the same year (2007). Based out of the state of Telangana, the Foundation bears my mother’s name (Ushalakshmi Breast Cancer Foundation) to honour her struggle in the fight against breast cancer. Over the past 12 years, the Foundation has left no stone unturned in its mission to transform breast cancer from a “taboo” issue to a much commonly discussed one through a number of innovative initiatives, thus creating the much-needed awareness about ‘early detection’.
Population based breast cancer screening
With the singular aim of ensuring early detection of breast cancer and save more lives, Ushalakshmi Breast Cancer Foundation has implemented South Asia’s largest population-based Breast Cancer Screening Programme by way of Clinical Breast Examination (CBE) in 15 districts of southern Indian states of Telangana and Andhra Pradesh. Between 2012 to 2016, well over 200,000 underprivileged women between the ages of 35 to 65 years spread across 3,990 villages have been screened for signs of early breast cancer by 3,065 trained healthcare workers.
Breast cancers detected through this initiative have offered treatment free of cost through the state Government funded scheme. Impressed with this successful large-scale initiative, since the beginning of 2018, the Union Ministry for Health and Family Affairs has been implementing population-based Breast Cancer Screening Programme by way of CBE all across the country.
A dedicated breast surgical society – “The voice for breast surgery” in India
In an effort to standardise delivery of breast surgery and pave the way to develop breast surgery as a distinct subspecialty in India, The Association of Breast Surgeons of India (ABSI) was formed in 2011 mirrored upon The American Society of Breast Surgeons (the largest society of breast surgeons in the world), Association of Breast Surgeons in United Kingdom & Association of Breast Surgeons of Australia & New Zealand. ABSI is the first and only organisation in South Asia that represents General Surgeons, Surgical Oncologists and Plastic Surgeons involved in the management of breast disease.
Starting from 2016, the standardised ABSI Training Module is being rolled out in every state across the country, which aims to empower General Surgeons working in towns and villages on every aspect of delivering effective breast healthcare. ABSI also aims to create public awareness about the importance of early detection of breast cancer, strengthen the concept of ‘patient advocacy’, and equally, impress upon the Government of India that early detection of breast cancer must become a political priority.
Conclusion
There is a need for a paradigm shift in the management of breast healthcare in India. The concepts of breast centre, breast surgical society, breast specialists, breast cancer advocacy and implementation of population-based breast cancer screening are all bound to improve the delivery of breast healthcare in the country.
There are turning points in everyone’s life. Working towards accomplishing my vision in the country, that I was born and raised in, over the past 12 years has given me great satisfaction.