In urban areas of developing countries, breast cancer is the most common cancer in women and due to increase in life expectancy, urbanization, and western lifestyles; the incidence has been rising up in low- and middle-income countries steadily in the last few years.
The incidence of breast cancer is low in India as compared to developed countries, but the total number of cases and the mortality is high probably because of the large population, inadequate screening programs, and lack of education. 1) The point at which patients seek medical attention in India is most often at the advanced stages of the disease. 2) The median age of the patients at first diagnosis of breast cancer in most hospital series is a decade lesser than that reported in Western series.
The first clear demonstration of the molecular diversity in breast cancers was reported by Perou et al.. Subsequent studies on breast cancer specimens from women across diverse geographies and demographics world-wide have confirmed the universality of these molecular classes and their relationship to the well-established immunohistochemistry (IHC) based clinical hormone receptor subtypes.
Much of the variability in clinic-pathological characteristics between reports from Indian centers is most likely due to the unavoidable sampling bias that is present in any hospital based caseseries. In addition, technical factors involved in IHC based hormone receptor detection and changing cut-offs over the years have contributed their bit to the varying proportions of ER positive tumors reported in these series.
In this study, we have examined the clinico-pathological variables of breast cancers treated at the All India Institute of Medical Sciences (AIIMS) , a regional center at Delhi in North India during a single calendar year, 2017.
Our study confirms the three cardinal features of the clinical epidemiology of breast cancer in India that has been noted in multiple studies, namely, 1) Presentation for medical care at a late stage; 2) Lower median age at first diagnosis and 3) Higher proportion of HR negative and TNBC tumor sub-types. Additional in-depth examination of clinical and pathological characteristics of the individual sub-types confirms that while the proportions are different each of the sub-types has the same inherent properties reported universally.
In India, for the year 2012:
144,937 women were newly detected new breast cancer. 70,218 women died of breast cancer. 144937/70218 = 2.06 = round it off to 2. So roughly, in India, for every 2 women newly diagnosed with breast cancer, one lady is dying of it.
Over 100,000 new breast cancer patients are estimated to be diagnosed annually in India and premenopausal patients constituting about 50% of all patients.
By 2020, breast cancer incidence will overtake cervical cancer as the most common cancer in women in India and 70% of the world’s cancer cases will be in poor countries, with a fifth in India.
In the last 100 years breast surgery has moved a full circle started with lumpectomy and moved towards radical mastectomy coming back to conservative surgery with neoadjuvant chemotherapy and radiotherapy.