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Journalism of Courage
Thirty-five-year-old Sheela Sinha had no idea that a painless lump in her breast, six months after giving birth, would turn out to be cancerous, spreading to her lungs and liver. Despite belonging to a well-to-do family, they did not get her tested and relied on alternative medicine instead. Her condition deteriorated rapidly and by the time Dr Sanjoy Chatterjee, a senior clinical oncologist at Tata Medical Centre in Kolkata, got to see her, her cancer had spread and palliative care was the only option.
“This illustrates how women get left behind despite breast cancer being the world’s most common cancer and significant improvements in research and treatment,” says Dr Chatterjee, a co-author of the new Lancet Breast Cancer Commission report on gross inequities in detection, outreach and care of patients. The panel calls this apathy a global blunder and has set out recommendations to tackle it.
Dr Chatterjee recalls how his patient’s husband, realising the end-stage nature of her illness, even stopped accompanying her to the hospital. “Her businessman husband simply abandoned her upon understanding that she wasn’t improving. Her mother would bring her to the hospital for treatment,” he says.
Although multiple reports have flagged breast cancer as the most common cancer among women in India (with around two lakh new cases per year), patients with metastatic breast cancer (MBC) (when cancer has spread from the breast to other parts of the body) are abandoned. “They are systematically left behind due to inaction on equities and hidden suffering. This is unacceptable,” argues Dr Chatterjee.
Global breast cancer incidence is estimated to rise from 2.3 million new cases in 2020 to over three million by 2040. One million deaths per year are projected during the same period with low- and middle-income countries affected the most.
First and foremost is late diagnosis and poor prognosis in women. Says Dr Minish Jain, senior medical oncologist (not attached with The Lancet Commission), “Since healthcare is expensive and there is a short supply of skilled professionals, the only way forward is early detection. The lump does not hurt and hence women do not seek early care. A simple clinical breast exam and awareness may help.” The commission report also recommends training paramedical and community staff to achieve this goal.
Second, there is a need to be prepared for dealing with future prevalence. “Which means we need a solid database and find areas to drive research so that there is an uplift in the quality of life of a breast cancer patient,” Dr Chatterjee says. According to Globocan, one Indian woman gets diagnosed with breast cancer every four minutes. So one in 28 women are expected to develop breast cancer during their lifetime. A 15 per cent rise has been estimated by 2025 as per multiple reports. “A structured plan has been initiated by the Government and a report is in the final stages by the National Association of Medical Sciences,” he says.
Third, there is a need to record cases of relapse in cancer registries and build an awareness around MBC. “India can show a way in this,” says Dr Chatterjee. The report points out how some patients feel ‘written off’. “This sense of being ignored and left behind can mean they are less likely to seek help or engage with research that could help them. Patients with metastatic disease need more support and information in order to feel valued,” says Lesley Stephen, collaborator and patient advocate.
All the 685,000 people, who died of breast cancer in 2020 globally, spent an estimated 120 million days suffering pain, shortness of breath, fatigue and other symptoms. Lancet surveyed 606 people living with breast cancer and found that some lost jobs during chemotherapy because of coping issues, others reported sexual dysfunction. Additionally, 20 per cent of participants with early breast cancer and 25 per cent of those with MBC reported difficulty in covering the costs of travel for treatment. About 27 per cent patients with early breast cancer and 35 per cent with MBC said they had financial problems. Hidden costs were another dampener.
That’s why breast cancer targets have to be measured and used to devise better, equitable approaches to therapies.
