Unlike many western countries, India lacks a widespread breast screening program. With rates of breast cancer rising in the country, is it time for population-based mammography screening? A recent symposium examined this issue, and a compilation of its findings was published April 28 in Cancer Causes & Control.
An international team of experts led by Jasmine McDonald, PhD, of Mailman School of Public Health at Columbia said that the prevalence of late-stage breast cancer in India -- and the country's high rates of breast cancer mortality -- occur because the most common tools for breast cancer detection in the country are clinical and breast self-exams, instead of mammography screening.
Breast cancer within the past 25 years has emerged as the second-most common type of malignancy in India. In terms of disability-adjusted life years, it is currently only surpassed by cervical cancer.
India also has one of the highest rates of the most aggressive subtype of breast cancer, triple-negative breast cancer, with rates being almost double that of the U.S. (28% versus 12%-15%).
Despite multiple breast cancer detection methods in existence, experts at the symposium could not reach a consensus on what screening modality -- including mammography -- would best serve the Indian population to downshift the stage at which cancer is presenting.
"Given the known limitations of mammography in dense breast tissue and in young women, [symposium] attendees agreed that population-based mammography would not be optimal as a population-based approach for screening particularly given the earlier age of onset in Indian women," the team wrote.
The authors also said ultrasound screening requires further investigation, and they cited concerns about overwhelming the healthcare infrastructure in India with false positives. They also could not conclude whether clinical breast examination would be sufficient.
"The challenge would be determining who should perform this and what training level is required to maximize benefit," they wrote.
However, the experts did recommend investigating some surrounding circumstances, such as the stigma around what it means to be a female in Indian society. This includes a woman's comfort level in performing a self-breast examination, as well as the more nuanced issue of asking questions about the risk of breast cancer or even seeking treatment.
"The recommendation is a multilevel effort to understand and address the core cultural barriers to body awareness that provides programming and resources for improved breast cancer prevention, detection, and treatment at all levels," McDonald and colleagues said.
They also called for improved standardization of molecular subtyping across clinical centers in India, improved existing infrastructure, and research examining environmental and early life exposures.
