Epidemiology of breast cancer in Manipur and its early detection

Ngangbam Sana Singh *

Introduction

Breast cancer is the most common form of cancer in women. About 10% of all cancer diagnosed were found to be breast cancer worldwide annually. According to American cancer society (ACS), about 276480 new cases of breast cancer were reported and about 42170 cases were expected to be death due to breast cancer in 2020.

According to International agency for Research on Cancer Asia has the highest number of cases about 911014 cases and about 310577 death cases in 2019. In our state Manipur also, breast cancer is the most common.

As per the ICMR report of 2017, the prevelance of different types of cancer in female is summarised as below: (Fig1)

The advancement of early detection makes a huge change in the mortality rates. Early detection aims to diagnose the breast as early as possible before metastasis where it is localized to the origin. Early detection makes effective treatment and successful outcome and cost effective. Self examination and clinical examination are the best method for early detection.

Public education and continuing education are also one of the important means for early detection of breast cancer. Public education helps the public or gives knowledge about the symptoms and or causes of the disease. Most of the uneducated public or people think it cannot be treated but by public education they can understand about the disease that breast cancer is not that formidable disease.

As there is no well define cure for breast cancer, early detection combined with proper treatment is recommended to reduce mortality rate. If there is no proper treatment or health care services for breast cancer, the program for early detection become less effective or in other word it have limited value. To reduce mortality rate treatment should be available and affordable to those women with the disease.

Under the guidelines of World health organization (WHO), the global summit early detection panel suggests to promote women empowerment for giving them proper health care, to developed proper infrastructure for diagnosis and treatment of breast cancer, to give proper education and awareness about the breast cancer even to include mammography.

Epidemiology

It is found that prevalence is highest in 70-74 age group. It also shows that there is distinct rise from 30-34yrs age onwards. Different ethnic groups are inhabitant in Manipur. Among the groups, most breast cancer cases belongs to Meitei community. The details are shown in below (Fig 2)

Causes and risks factor

As the cause of breast cancer is not directly understood. A number of factor such as genetic predisposition, physiology, hormone and environmental factor can lead to breast cancer. Changes or mutation in DNA cause normal breast cell to become cancer cells. A high risks of developing breast cancer by about 70% in women with variants in BRCA1 & BRCA2 has been found compared to women in general population who have 10% risk by the age of 80.

Other factors such as increasing in age, exposure of ionizing radiation, alcohol consumption, hormones, increasing breast density, life style of a person also increased the possibility of developing breast cancer.

Numerous studies have reported that the risk of developing breast cancer increases with alcohol consumption in women is about 7-10% for each 10gms. And comparing to women who are physically inactive , a women who get regular physical activity have a lower risk about 10-20% of developing breast cancer.

Genetic predisposition

The chances of developing or occurring breast cancer is high in the family where there is a family history of breast cancer cases such s mother , daughter or sister . Comparing to an individual without family history, an individual having family history have about 1.5 times higher risk factor for the disease.

Mutation in these two tumor suppressor gene BRCA1 & BRCA2 are the major cause of developing breast cancer. About 5-10% of all female breast cancer are found to have genetic variation in BRCA1 & BRCA2 .

Hormonal factor

Regulation of hormones is also another important factor for the development of breast cancer. Women who have used estrogen and progesterone therapy increased the risks of breast cancer by 26% compare to women who have not used.

Female who begin menstruating before the age of 11 have about 20% of breast cancer than female who begin at the age of 14. And those female who have menopause at 55 or above have the high risk of about 12% than who have at 50-54 age.

Detection method

1) Self examination

Self breast examination is done in order to learn about her breasts how the look, feel so that they can easily identify the changes when there is any changes in the breast. Breast self examination is normally done by standing in front of a mirror. They can examine by visual or by touching the breast. They can examine in different positions such as with arms raised,arms on the hips, squeezing the nipple.

2) Clinical Examination

Clinical breast examination is mostly done by doctors, nurse , health care professional for Examining the breast. Here the breast of the women is examined by the experts by inspection or looking the breast or by palpation of the breast. They will identify any changes in the appearance of the breast, any asymmetric or abnormal discharge from the nipples. Clinical breast examination should be done periodically or routinely.

3) Mammography

Mammography is a X-ray imaging techniques used for detection of lesions in the breast. It required well trained technicians, radiologist and it is cost effective. The results of these techniques may varied from one person to another as it depends on the density of the breast. Besides it has a disadvantage as it may give false positive results or false negative results, thus lead to further testing and overdiagnosis and create problems with those a financially problem person.

Use of ionizing radiation is another issue in mammography. Women in younger age give most negative results. Results from organized mammography in Europe indicates that the risk of breast cancer was reduce more than 40% among the women who were screened.

4) Ultrasound

Ultrasound is a screening tool which use acoustic waves to detect tumor. It can identified the structure of the breast and can easily differentiate between cysts and a solid mass. It is similar with mammography but it can give a better view of lesions on the breast. Ultrasound along with mammography gives a better image and help in biopsy rates. It is recommended for pregnant women who cannot use radiation for sc reening.

5) MRI ( Magnetic resonance imaging)

Magnetic resonance imaging (MRI) use strong magnetic waves to detect the tumor. This technique has a high sensitivity of about 91-95% but its specificity is low about 26.4% . According to American Cancer society, MRI is suggested for the women with high risk of breast cancer development and BRCA mutation. But it is not commonly used by the general population because of its false positive results, need of expert and cost.

After the age of 30, a women who have a lifetime risk of at least 20-25% of breast cancer due to the presence of BRCA1 & BRCA2, an annual screening of MRI is recommended in addition of mammography.

6) Biomarkers

Biomarkers such as protein biomarkers and gene biomarkers are mostly used to detect the tumor. Protein biomarkers such as heat shock protein 60 (HSP60) , HSP90 , human epidermal growth factor receptor 2 ( HER2) are commonly used. Tumor suppressor gene BRCA1 and BRCA2 are also used for breast cancer susceptibility.

Public education

It is the most simple way in which women are given with proper education so that they can know about their breasts. It can be easily done through simple ways such as television, radio, advertising even on social media. Information about the breast cancer should be provided such as sign and symptoms of breast cancer, early detection methods.

Public education must also gives knowledge about its treatment and if not treated in early stages even can caused to death . Breast Cancer can be diagnosed not a formidable. By giving knowledge to the public they can easily know about their changes in the breast which eventually make early detection possible.

CONCLUSION

Since the prevalence of the breast cancer is enormously increasing day by day early detection of the breast cancer is much important. This is again depend upon the development of modern technology and public awareness. Many modern techniques are developed in the medical field. Even the modern technology is in advance stage many early detection methods or techniques are available for early detection of breast cancer.

But these techniques are not 100% accurate they may have some false results. Density of the breast, age are one of the main reason of these false results. Techniques along with self breast examination and clinical examination can easily detect breast cancer in the early stage. We need to study more and more for the development of several biomarkers for the early detection of breast cancer.

Detecting breast cancer at early stages gives more successful treatment and hence reduced death rate. Above all these public education helps in early detection of breast cancer which makes them less toxic treatment and cost saving.

Reference:

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