Innovative approaches to breast cancer detection and treatment: A call to action on World Cancer Day
Breast cancer remains a significant health challenge in India. According to the WHO’s Global Cancer Report (2022), India records approximately 200,000 new breast cancer cases annually, contributing to 14% of the country's total cancer burden. While the incidence rate in India (37 cases per 100,000 population) is lower than in high-income countries (90-100 cases per 100,000 population), the mortality rate is significantly higher. This is primarily due to late-stage detection, with nearly 60% of cases being diagnosed at stage 3 or 4, leading to poor treatment outcomes and increased fatalities. Major risk factors are changing life style, obesity, increasing smoking and alcohol consumption, late childbirths
One of the biggest challenges in breast cancer management is early detection, particularly in rural and low-resource settings. A thorough examination of breast by nurse or any a trained healthcare worker like nurses is enough to diagnose breast cancers at early stages, in women in India. This is a low-cost intervention and does not need any equipment. It is easy to perform as well as easy to undergo for women
Despite its advantages, less than 2% of women in India have undergone breast cancer screening, as per the National Family Health Survey (NFHS).
Dr. Anita Gadgil, Senior Research Fellow, Program for Global Surgery and Trauma, The George Institute for Global Health, India, said, “A key barrier is the societal stigma associated with breast cancer across all socio-economic strata, and even among healthcare workers at the grassroots level. They often hesitate to inquire about breast health, despite routinely checking for conditions like hypertension and diabetes. Enhancing healthcare workers' capacity and trust in sub-centers and primary health centers (PHCs) is crucial If women perceive that PHCs lack diagnostic capabilities and that they will eventually need to visit larger hospitals, they are less likely to seek care, resulting in delayed diagnosis. Women ignore the lumps/ hide due to fear till it becomes advanced cancer. But we cannot blame rural women for late detection, as it starts from providers.”
Primary and secondary healthcare centers must be better equipped to facilitate early diagnosis. Even when a lump is detected at a PHC, the lack of accessible diagnostic cytology services—often located 3-5 hours away—discourages patients from undertaking the journey and bearing the cost. While PHCs have been strengthened for maternal care, a similar effort is needed for cancer detection and treatment. In normal delivery, women lose more blood than a simple oral cancer biopsy. Needle cytology of breast lump is easier than biopsy. Ultrasonography in our scenario the most effective way of diagnosing breast lump. These tests can be done at PHCs. PHCs lack consistent training and support to alley anxieties around these diagnostic tests and procedures
Some countries have successfully built cancer diagnostic capacity in the initial years of their cancer control programs before launching large-scale community awareness initiatives. India can learn from this approach by ensuring that screening programs are backed by robust treatment pathways so that diagnosed women receive timely care.
Preventive strategies, particularly lifestyle modifications, play a crucial role in reducing cancer risk. Bringing all parallel medicines streams and traditional lifestyle practitioners like yoga on board for modifying life styles will go a long way as they have better access and acceptability in the community, especially remote areas than tertiary cancer care centers.
Mastectomy, a key treatment for breast cancer, can be effectively performed at district hospitals if surgeons are systematically trained. Currently, breast cancer surgeries are confined to tertiary centers, while peripheral hospitals perform surgeries in an inconsistent manner without standardised guidelines. Training district surgeons would reduce the burden on tertiary care centers and ensure better, more uniform treatment outcomes.
Policy Recommendations for Accessible and Affordable Cancer Care Currently cancer treatment and diagnosis to a certain extent in India remains largely confined to tertiary care centers, excluding lower-tier healthcare facilities. A broader implementation of task-shifting strategies is necessary to expand the cancer care workforce. Training, certifying, and accrediting additional healthcare professionals for cancer control can help bridge the gap in diagnosis and treatment. Sonography, an effective tool for diagnosing breast lumps, remains underutilised due to its restrictions in prenatal sex determination. Additionally, palliative care—currently a neglected aspect of the non-communicable disease (NCD) agenda—requires urgent attention and integration into national health programs.
Further, Dr. Anita Gadgil, said, “The time is right and we have the capacity to integrate AI, mobile based apps, telemedicine and come up with low-cost interventions where we cannot reach as providers. Very few programs are currently building this in research agendas, more so we have done much research in redefining the problem whereas solution-based research is either limited to high tech labs or directed at changing people’s behaviour towards cancer. A bit more inward and health systems approach on how care can be provided better, closer to homes is needed.”
A Call to Action on World Cancer Day On this World Cancer Day, let us shift our focus towards what we can achieve by more inclusive healthcare system. By leveraging existing resources, task shifting, building diagnostic and treatment capacity at all levels of healthcare, and adopting innovative approaches, we can significantly improve breast cancer diagnosis, treatment, and survival rates in India.
