New Delhi: The five-year survival rate after a breast cancer diagnosis in India is 66.4 percent, dismally low when compared to developed countries like the US where more than 90 percent women are alive five years after being diagnosed with the disease, a new Indian Council of Medical Research (ICMR) study has found.
The findings were the result of the “largest” population-based cancer survival research led by ICMR scientists and were published Saturday in the latest issue of American Cancer Society journal.
The analysis covered 17,331 women who were diagnosed with breast cancer between 2012 and 2015 from 11 population-based cancer registries (PBCRs), through which the ICMR systematically collects cancer-related data from across the country. The patients were followed till June 2021.
The 11 PBCRs were at Kollam, Thiruvananthapuram, Mumbai, Wardha, Ahmedabad urban, Kamrup urban, Manipur, Mizoram, Sikkim, Tripura and Pasighat.
The exercise revealed heterogeneity in cancer survival across the country, with a 33 percent disparity ranging from 41.9 percent in Pasighat (Arunachal Pradesh) to 74.9 percent in Mizoram. The national average was 66.4 percent.
Speaking to ThePrint, Dr Ravi Mehrotra, a cancer researcher who is also associated with the World Health Organization’s International Agency for Research on Cancer (WHO-IARC), said: “These findings are important and show that despite improvements in treatment modalities and advent of newer drugs to treat breast cancer, access remains a major challenge for the vast majority of patients in India.”
The study did not elaborate on why the survival data was starkly different in Mizoram and Arunachal Pradesh, two Northeastern states with similar health facilities and services.
Mehrotra, however, opined that this could be attributed to delayed diagnosis and timely access to treatment facilities, which are significant contributors in improving cancer survival.
The analysis also showed that patients diagnosed with local-stage cancer had a 4.4 times greater five-year survival rate than those diagnosed with distant-stage cancer.
In addition, patients older than 65 years had a 16 percent lower chance of survival compared with those aged 15-39 years.
According to the ICMR’s National Cancer Registry Programme (NCRP), over 2 lakh cases of breast cancer — a leading cause of death among women in India — are detected in the country every year, and while one in 22 women develop the disease, nearly half of those who do, die due to it.
Through the NCRP, cancer data is collected via 38 PBCRs. This involves data collection from a well-defined population via multiple sources of registration, such as government and private hospitals, diagnostic labs and the registrars of births & deaths, apart from 189 hospital-based cancer registries.
The latest study underlines that breast cancer is the most common cancer in India, accounting for 28.2 percent of all female cancers, with an estimated 2,16,108 cases in the nation by 2022.
The incidence rate of this cancer has increased by 39.1 percent from 1990 to 2016, and this trend has been seen in every state of India over the past 26 years.
A 2022 paper on breast cancer in India, co-authored by Mehrotra, had highlighted that the survival rate of patients with breast cancer was poor in India as compared to the western countries due to earlier age at onset, late stage of disease at presentation, delayed initiation of definitive management and inadequate or fragmented treatment.
The same paper had highlighted that nearly 60 per cent of breast cancer cases in the country were diagnosed at late stages, leading to poor prognosis.
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Astounding disparities
According to the study, five-year survival of patients with breast cancer was higher than the national average of 66.4 percent in Mizoram (74.9 percent), Ahmedabad (72.7 percent), Kollam (71.5 percent) and Thiruvananthapuram (69.1 percent).
Conversely, Pasighat in Arunachal Pradesh had the lowest survival rate at 41.9 percent.
The observed five-year survival rates for localised, regional, and distant metastasis in all cancers were 81 percent, 65.5 percent and 18.3 percent, respectively.
“Breast cancer survival in India has improved slightly, but it still lags behind that in developed countries,” the authors noted.
Comprehensive cancer control strategies have to be implemented widely in the country, they asserted, adding that early detection programmes, including breast cancer awareness and cost-effective screening, along with accessible and affordable multimodality treatment, survivorship care, and palliative care, have to be prioritised.
According to the researchers, “newer treatment options, such as targeted therapies and immunotherapies, have been shown to improve the prognosis of certain subgroups of patients with breast cancer, but access to such expensive choices are extremely limited in a low-income to middle-income country like India”.
(Edited by Nida Fatima Siddiqui)