THE BATTLE AGAINST INDIA'S RISING BREAST CANCER CRISIS

India stands at a pivotal moment, blending global innovation with local needs to transform breast cancer from a silent killer into a manageable disease.

- By Nehal Gautam

Breast cancer is a mounting crisis in India, with over 200,000 new cases yearly and a mortality rate surpassing many developing nations.

Unlike Western countries, where diagnoses peak around 60, India's patients are younger, typically 45-50, driven by urbanization, delayed childbearing, and lifestyle changes. Globally, breast cancer claims over 600,000 lives annually, but India's five-year survival rates plummet to 40% in rural areas versus over 90% in urban centres. Late-stage diagnoses dominate rural regions due to low awareness, cultural stigmas, and scarce diagnostics, leaving women with advanced stage III or IV disease and limited treatment options. Urban hubs like Mumbai and Delhi, however, offer world-class care, sentinel node biopsies, oncoplastic surgeries, genomic profiling, and therapies like CDK4/6 inhibitors and antibody-drug conjugates (ADCs), rivaling global standards.

Screening remains a bottleneck. The NPCDCS promotes clinical breast examinations (CBE) from age 30, practical but less effective than mammography, especially for dense breasts (BI-RADS C/D) common in Indian women aged 40-55. Mammography uptake is a mere 1-2% among women over 45, and adjunct tools like ultrasound or abbreviated MRI are scarce due to cost and availability. Global therapies, trastuzumab deruxtecan for HER2-low, pembrolizumab for TNBC, and ctDNA-guided monitoring, are transforming care, but rural patients face high costs and uneven access to PET/MRI or digital breast tomosynthesis. Surgery is advancing with breast-conserving oncoplastic techniques and reduced axillary dissections, yet rural hospitals lack trained surgeons and equipment. Policy gaps, like weak referral systems and CBE's limitations, exacerbate disparities.