Ladies, let’s have an honest chat. Balancing work, family, and life’s chaos is tough. I agree. But in this pursuit, are we neglecting our health, which could make achieving everything else tougher?

Recently, we were all shocked to hear about Hina Khan, the famous TV star, being diagnosed with stage 3 breast cancer.^[1] Although she is lucky to be back to work now after surgery^[2] and amidst chemotherapy,^[3] Hina’s story is a grave reminder of how crucial it is to catch breast cancer early. Late diagnosis can drastically reduce the chances of survival, making it a battle not just against cancer but against time.

Did you know that breast cancer survival rates can vastly differ based on when it’s detected? If caught early (stage-1), your chances of being alive after five years can be 99%. But if detected late (stage-4), this can plummet to 20%.^[4] These numbers are a wake-up call for all of us.

On average, 50% of breast cancer cases in India present at a late stage (stage III and IV). Whereas in developed countries like the United States, only 12% of breast cancer cases are diagnosed.^[5]

What are the critical reasons for late detection in India?

First, you need to be more responsible for your breast health in India as there are no government-mandated regular breast screening programs pushing eligible women to screen themselves like in some developed countries.

Second, there are so many myths out there that can lull us into a false sense of security. To debunk a few:

Myth 1: A lump is the only symptom of breast cancer: Incorrect. It takes two to five years of growth^[6] for breast cancer to be felt even by the trained hands of a doctor. By then, it is already at least 2 cm in size and has probably spread to the armpit. Whereas mammograms can detect breast cancer very early. Hence, whether you have any symptoms or not, yearly mammography is recommended by the Breast Imaging Society of India (BISI)^[7], American College of Radiology (ACR)^[8], and several other global authorities if you are eligible by age (40 years) or additional risks (earlier). Breast cancer can also show up as changes in breast size, shape, skin texture, or even nipple discharge. Any unusual changes should prompt a visit to your doctor. Most importantly, early detection, much before any symptom, with mammography,is crucial for survival.

Myth 2: Family history is the only significant risk factor: Not true. Only 5%-10% of breast cancer cases are associated with a family history.^[9] The vast majority of breast cancers occur due to unknown causes and factors such as environment, lifestyle, obesity, etc. Hence, even if you have no family history of breast or any other cancer, please subscribe to an annual mammography schedule once you are 40 years old. For women with a family history or any other additional risk, the doctors may recommend it from a younger age.

Myth 3: Only older women are at risk: While it’s true that breast cancer risk is often associated with women over 40, younger women are not immune. That’s why it’s crucial to understand your risk factors and make informed decisions about your health. If you have high breast density, a family history of breast cancer, a personal history of previous breast lumps (including non-cancerous), early menstruation before the age of 12 ^[10], certain genetic mutations, etc., it might become unsafe for you to wait until you’re 40 to begin routine annual screening mammograms.

Myth 4: Mammograms are painful. Fact: Getting a mammogram done today differs from the olden days. The newer, ergonomically designed compression pads minimize discomfort, and some latest 3D mammography machines take just 3.7 seconds to scan, significantly minimizing the compression time. Also, a study^[11] points out that your memories of your last mammography experience are a good predictor of your next one. Hence, try not to be anxious before your next mammography; you may feel alright.

Myth 5: Mammograms expose me to harmful radiation, which may cause cancer. Fact: Mammograms use very low-dose radiation within the strict guidelines approved by the medical and regulatory authorities. Some of the latest 3D mammography machines expose you to even lower radiation than these statutory doses. Also, mammography radiation is equal to about two months of atmospheric radiation that we are all exposed to every day. The benefits of screening mammograms far outweigh the risks of this small radiation exposure.

In conclusion:

Understanding the dreadful consequences of late breast cancer diagnosis can empower you to stay breast-healthy. Here are some general tips for your action:

• Never miss your annual mammogram: Annual mammograms are vital. They can detect breast cancer early when it is most treatable. Don’t rely on breast self-exams or other modalities. Make it a priority to schedule your yearly screening even if you feel perfectly healthy.
• Select the right mammography center: You may have many options at your place to get a mammogram done, such as a diagnostic lab, a hospital, or a dedicated breast clinic. How do you select one among all available choices? Here are three easy steps to help you choose the right mammography center.
• Overcome your mammography anxiety if you have any: If you feel anxious before a mammography session, you are not alone. Your stress could be due to either it being your first mammogram, your fear of discovering cancer, myths harboured in your mind, or your past uncomfortable experience. Whatever your reason, it’s important to remember that mammograms save lives, and here are seven tips to help you relax before your next mammogram.
• Stay informed. Stay healthy: Your family needs you forever. Your health is as important to them as it is to you. Keep up with the latest research and reliable information on mammography and breast health. Follow healthy routines and medical advice to protect yourself and your loved ones.
• Take timely actions: The best protection against breast cancer is early detection. Hence, if you are eligible for breast screening either by age (40 years and above) or due to high-risk factors such as family history (in which case even if you are younger than 40 years), subscribe today to an annual screening mammography plan at a center near you and never miss your test—a simple ritual that can save your life!

1. https://www.outlookindia.com/art-entertainment/television/hina-khan-shares-her-mothers-reaction-after-cancer-diagnosis-praises-her-for-being-a-pillar-of-strength Accessed 25 July 2024
2. https://indianexpress.com/article/bollywood/hina-khan-undergoes-surgery-following-breast-cancer-diagnosis-hits-back-at-trolls-with-a-powerful-note-being-constantly-in-pain-9458401/  Accessed 25 July 2024
3. https://www.indiatoday.in/television/celebrity/story/hina-khan-resumes-shoot-after-first-chemotherapy-2567142-2024-07-15 Accessed 25 July 2024
4. Giaquinto AN, Sung H, Miller KD, et al. Breast Cancer Statistics, 2022. CA: A Cancer Journal for Clinicians. 2022;72(6). doi: https://doi.org/10.3322/caac.21754
5. Sathwara J, Bobdey S, B. G. Breast cancer survival studies in India: a review. International Journal of Research in Medical Sciences. Published online 2016:3102-3108. doi: https://doi.org/10.18203/2320-6012.ijrms20162266
6. https://oregon.providence.org/forms-and-information/a/ask-an-expert-breast-cancer-growth-rate/
7. https://www.bisi.co.in/guidelines/mammography/
8. https://www.acraccreditation.org/Mammography-Saves-Lives/Guidelines
9. Liu, L., Hao, X., Song, Z. et al. Correlation between family history and characteristics of breast cancer. Sci Rep 11, 6360 (2021). https://doi.org/10.1038/s41598-021-85899-8
10. https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm accessed on 13 Jan 2024
11. Kornguth, Phyllis J.a,*; Keefe, Francis J.b; Conaway, Mark R.c Pain during mammography: characteristics and relationship to demographic and medical variables, Pain: August 1996 – Volume 66 – Issue 2 – p 187-194 https://www.sciencedirect.com/science/article/abs/pii/0304395996030576