Epidemiology of Breast Cancer in Indian Womens

1. Epidemiology of breast cancer
in Indian women
S. Malvia et al. (2017)
Asia-Pacific Journal of Clinical Oncology
(Review Article)
Sushil Patel

2. Introduction
•Breast cancer is the leading cause of oncogenic death among women, accounting for
nearly 25% of all cancers among women.
•Women from less developed regions (883 000 cases) have slightly more number of cases
compared to more developed (794 000cases) regions.
•In India, although age adjusted incidence rate of breast cancer is lower (25.8 per 100 000)
than United Kingdom (95 per 100 000) but mortality is at par (12.7 vs. 17.1 per 100 000)
with United Kingdom.
•Earlier cervical cancer was most common cancer in Indian woman but now breast cancer
has surpassed cervical cancer, although cervical cancer still remains most common in rural
India.
•The objective of this review article is to bring together the information scattered in
different Indian registries and studies to see a broader picture of breast cancer
epidemiology in Indian subcontinent.

3. Methods
•Multiple sources from literature were used for gathering information and analysis of breast
cancer.
•Information on crude rate (CR) and age adjusted rate (AAR) per 100,000 population was
collected from National Cancer Registry Program reports 2012-2014 and twenty-five
population-based cancer registries (PBCRs) across India.
•Besides many review articles were also screened for the filtering out of the data regarding
epidemiology of breast cancer in Indian women.
•National Cancer Registry Program reports on time trends in cancer incidence rates (1982–
2010) from 13 PBCRs (Bangalore, Bhopal, Chennai, Delhi, Mumbai, Barshi,
Thiruvananthapuram, Dibrugarh, Kamrup Urban District, Imphal West District, Ahmedabad
Rural District and the states of Mizoram and Sikkim) were also used for projection of annual
percentage change (APC) in burden of breast cancer.

4. Burden of breast cancer in
Indian population
•According to Globocan 2012, India along with United States and China collectively accounts for
almost one third of the global breast cancer burden.
•India is facing challenging situation due to 11.54% increases in incidence and 13.82% increase
in mortality due to breast cancer during 2008–2012.
•Increasing urbanization and westernization associated with changing lifestyle and food habits
has made breast cancer to attain top position in all major urban areas, whereas in rural areas still
cervical cancer is at top position in females followed by breast cancer.
•Mortality/incidence ratio (MIR) is another novel measure to evaluate cancer mortality in relation
to incidence. It is used to identify whether a region has a higher mortality than might be expected
based on its incidence.
•Barshi rural has MIR as high as 66.3 projecting a very high mortality rate inspite of low
incidence of breast cancer in rural India.
•However, Delhi registry had a low MIR of 8.0 despite having high incidence (28.6%), possibly
due to high literacy, more awareness and availability of better medical facilities in metropolitan
cities.

6. Age wise breast cancer
trends

7. Risk Factors
Increasing age, obesity
Household activities
Betel nut and tobacco
Chewing habits
Higher lifetime exposure
of oestrogen and progesterone
Polycyclic aromatic
hydrocarbons
Inherited familial risk

8. Time trends of various
cancer registries

9. Projection of burden of
breast cancer
•Cancer projections are useful especially in a developing country like India, where there is an
urgent need to plan and prioritize health care services including both diagnostic and treatment
facilities.
•Breast cancer projection for India by the time period 2020 suggests the number to go as high
as 1,797,900 with its approximately relative percentage remaining same 10% among all the
cancers.

10. Conclusion
•Breast cancer, the major cause of morbidity and mortality among females ranks number one
among females in Indian metropolitan cities, whereas in rural areas such as Barshi it still hold a
second position.
•The increasing trends for incidence and mortality is mainly due to rapid urbanization,
industrialization, population growth and ageing affecting almost all parts of India.
•Delayed disease presentation due to illiteracy, lack of awareness, financial constrains in some
regions of India leads to late diagnosis, which in turn increases mortality rate.
•Lack of organized breast cancer screening program, paucity of diagnostic aids, and general
indifference towards female health are also the drawbacks leading to increased breast cancer
incidence.
•A multidisciplinary approach to breast cancer including awareness programs, preventive
measure, screening programs for early detection and availability of treatment facilities are vital
for reducing both incidence and mortality of breast cancer in Indian women.

11. Thank You