Breast Cancer Time Bomb: What India Can Learn From Japan's Early-Stage Intervention

Breast cancer is the most commonly diagnosed cancer variant among women worldwide and it causes the maximum number of cancer deaths among them. In terms of the overall cancer death, too, it is the fourth major cause of death, globally. In India, the situation is no different. A recent study by a leading healthcare group found that the cases of cancer and other non-communicable diseases are disturbingly rising in the country. It also reflects the emerging health hazards and the overall decline in the country’s preventive mechanisms.

Breast Cancer Time Bomb: Cause Of Concern

Rapid urbanization, severe air pollution and rising lifestyle diseases amplify the causes of cancer, especially breast cancer, among women. The study estimates that the number of annual cancer cases may reach 1.57 million by 2025. Breast, cervical, and ovarian cancer are the most common forms affecting women, and those commonly affecting men are cancer in the lungs, prostate and mouth.

Early Victims

According to the study, people in India are getting cancer at relatively lower ages compared to the Western countries. The average age of breast cancer diagnosis in India is 52, but it is 63 in the US and Europe. The average age of lung cancer diagnosis is 59, while it averages around 70 in the West.

Despite this looming challenge, India doesn’t have an exclusive cancer detection and prevention programme. Instead, all the cancer-related initiatives fall under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS), which was launched in 2010 with a focus on strengthening infrastructure, human resources, early diagnosis, management and referral. Non-communicable diseases (NCDs) like cancer and cardiovascular diseases are estimated to cause around 60% of all deaths in the country.

Alarming Growth

Breast cancer has become one of the most pressing public health challenges, contributing to an alarming rise in the nation’s cancer burden. The burden is on a sharp ascent with 1.41 million new cases reported in 2022, and breast cancer is contributing significantly to this number. A study conducted by the Indian Council of Medical Research (ICMR) across 11 Population-Based Cancer Registries (PBCRs) found that breast cancer accounted for a staggering 28.2% of all female cancers. Notably, survival rates differ significantly by region, with Mizoram, Ahmedabad-urban, and Kollam and Thiruvananthapuram in Kerala recording higher-than-average survival rates, while areas like Pasighat (Arunachal Pradesh) lagged behind with a five-year survival rate of just 41.9%.

Survival Rate

The ICMR study further noted that patients diagnosed at the early stage of the disease were 4.4 times more likely to survive compared to those diagnosed at an advanced stage. Additionally, women over 65 had a 16% lower chance of survival than those aged 15-39, emphasizing the importance of early detection, particularly among younger women.

Early Detection

Periodic screening will help people detect breast, cervical and lung cancers at a very early stage. A shocking finding in the healthcare group’s study is that cancer screening rates in India are very low. Breast cancer screening is only 1.9% compared to 82% in the US, 70% in the UK and 23% in China. Cervical cancer screening is awfully low at 0.9% against 73% in the US, 70% in the UK and 43% in China.

Patients often seek medical care only when the cancer has progressed to advanced stages. More than 60% of cases are diagnosed at stage 3 or stage 4, significantly reducing the survival prospects. At these stages, breast cancer is like a time bomb, as it hits its final time, spreading to all nearby organs in the body a cure becomes impossible. However, in regions where early diagnosis is prevalent, like Mizoram and Kollam, survival rates are comparable to the Western nations.

Japanese Model

Limited access to treatment facilities further exacerbates the issue, particularly in rural India where poverty, lack of education, and inadequate healthcare infrastructure impede timely diagnosis and treatment. Although urban areas report higher incidences of breast cancer, rural women face a disproportionate risk of late-stage diagnosis due to limited awareness and poor health infrastructure.

One of the significant challenges India is facing is the delay in diagnosis. Accessibility and affordability continue to be a major problem here. India can take a leaf out of Japan’s book in this domain. Japan emphasizes preventive care. Regular health checkups, early detection screening and a focus on lifestyle diseases are integrated into their system. This is driven by effective public campaigns and educational initiatives. Similarly, India should promote a culture of early screening and regular checkups, which are not only affordable but also help people avoid costly treatments at advanced stages. Further, technology has made it much easier with the advent of artificial intelligence (AI) and data analytics. In Japan, AI-driven diagnostics have brought a paradigm shift in the preliminary screening and detection of cancers, emphasizing the importance of early-stage intervention.

Lifestyle Matters

Lifestyle changes such as diet, physical activity, and reproductive history play a critical role in breast cancer risk. Obesity, particularly after menopause, is a significant risk factor. In urban India, where women increasingly adopt Western dietary habits, the incidence of breast cancer is rising. The consumption of processed foods, sedentary work culture, smoking and excessive alcohol consumption aggravates the situation.

Age Factor

Age is a significant factor in breast cancer survival. While Western countries tend to see breast cancer mostly in postmenopausal women, India is witnessing a worrying shift toward younger age groups. Women between 30 and 50 years of age are increasingly being diagnosed, with risk peaking between ages 50 and 64. This trend is disturbing, as younger women often face more aggressive forms of the disease. Early detection is also critical for improving cancer survival rates. Randomized trials have shown that clinical breast examinations significantly increase the chances of detecting breast cancer at an early stage when treatment is more effective.

Breast cancer nowadays is more than a health hazard. It is a time bomb waiting to explode. With the growing incidence of the disease, particularly among younger women, and the delayed diagnoses in rural areas, India is facing a crisis that requires immediate action. The Union government’s initiative to provide HPV vaccine to girls is laudable in this context. The country should urgently roll out similar programmes for early screening, detection and control of other types of cancers as any laxity on this front will lead to a human catastrophe of gigantic proportions, which will have huge economic and social fallouts. (ends)

Authored by Masaharu Morita, Founder and Program Director at NURA