A doctor couple, with the help of several other investigators in Kerala, has developed a tool that can assess the risk for a woman to develop breast cancer in her lifetime. The risk calculator, that throws up a score by answering a set of seven questions, can help women determine the kind and frequency of medical screening they require so that they can get diagnosed at the right time. Early detection has been proved to significantly raise chances of survival in breast cancer.
Dr Regi Jose, professor of community medicine at the Sree Gokulam Medical College in Thiruvananthapuram, and her husband Dr Paul Augustine, head of the division of surgical oncology at the Regional Cancer Centre (RCC) in T’puram devised the risk calculator after conducting an extensive study on the usefulness of Gail model in estimating the risk for development of breast cancer in women of Kerala.
The study, which was a part of the thesis of Dr Jose, was conducted between June 2003 and March 2005 at the RCC and in corporation areas of T’puram with a sample size of 1580 that included women diagnosed with breast cancer and those without a history of it. It found that the Gail model was ‘less sensitive’ and that major risk factors among the study population were increasing age, previous breast biopsy, first-degree relatives with breast cancer, late age at first live birth (FLB) and not breastfeeding, In short, Gail’s tool may have been useful in the US, but not as useful to identify high-risk women in our society.
“The sensitivity of the Gail model among women here was found to be only 14.2 per cent and so it may not be useful here. So to understand the risk among women here and help develop a score, I did statistical modelling and created a logistic regression equation. With the help of seven variables, the calculator we devised can do a risk prediction ranging between 0 and 1,” said Dr Jose, who’s also the medical director of Snehita, an NGO that works on early detection of breast cancer among women. In fact, it was the technical team at Snehita that converted the doctors’ formula into an online calculator that can be accessed easily on its website (snehita.in/risk).
“The sensitivity is 76 per cent so therefore the risk predicted is not an absolute value. However, we see it as a motivator for adopting early detection methods. Based on the score you get, it tells you how often you should be undergoing screening. If your score is below 0.5, you are at low-risk. Anything between 0.5 and 0.75 indicates moderate risk. A score higher than 0.75 shows you are at high-risk,” said Dr Jose.
The seven parameters that the calculator takes into account to create a score are current age, age at menarche, age at first live birth, number of live births, history of breast feeding, number of first-degree relatives with breast cancer and total number of breast biopsies. The tool is most accurate for women above 30 years of age. A higher score would mean the woman must undergo regular screening and check-ups. At the same time, Dr Jose underlines that a low score does not guarantee an absence of risk. Regular screening is important.
“We advise even those at low-risk to undergo a clinical breast examination from 30 years of age and a baseline mammogram at 50 years. For those at moderate risk, the frequency of clinical breast examination must be every six to twelve months. The problem with our people is that they undergo a mammogram or clinical breast examination just once and if there is nothing to suggest cancer then, they feel they are safe for life and do not continue to get checked later. That’s not how it works. There must be motivation for regular check-ups,” she said.
The harrowing truth, said Dr Jose, is that 50 per cent of breast cancer patients in Kerala are below the age of 50 with a significant share of younger women reporting the cancer. Early detection can ensure over 90 per cent cure of the disease through appropriate treatment with surgery the mainstay of treatment, she stressed.
In India, breast cancer today is the most common cancer among women, replacing cervical cancer and a woman is diagnosed with it every four minutes.
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