NEW DELHI: So what's the right age for an Indian woman to start getting
screened for breast cancer -- 40 or 50? Opinion is divided just like it is in
the US right now.
The United States Preventive Services Task Force (USPSTF) recommended on Monday
that regular breast cancer screening of women should start at the age of 50 as
opposed to 40, which is the suggested age right now in the US.
Publishing them in the journal "Annals of Internal Medicine", USPSTF recommended
against routine screening mammography in women aged 40 to 49 years and start
biennial screening mammography for women aged 50 to 74 years. It also said that
current evidence is insufficient to assess the benefits of screening mammography
in women 75 years or older.
Dr Diana Petitti, vice-chairperson of the task force, said, "The guidelines were
aimed at reducing the harm from overscreening. A test can trigger unnecessary
biopsies that can create extreme anxiety. And mammograms can find cancers that
grow so slowly that they never would be noticed in a woman's lifetime."
According to USPSTF's report, one life is saved for every 1,900 women aged 40-49
screened for breast cancer, compared to one life for every 1,300 in the 50-59
year age group.
However, just like in the US, the recommendations have started a storm in India
too. Some experts say India should stick to 40.
Dr Sidharth Sahni, surgical oncology (breast) expert at Artemis Health
Institute, said, "Women in India have started to get diagnosed with breast
cancer at an early age 42 to 44 years. So to start screening at 50 will be
futile. We should stick to 40 and screen women every year from then on. No
damage is recorded from radiation if taken after 10 months."
Dr Ramesh Sarin, surgical oncologist at Indraprastha Apollo Hospital, added,
"Getting a mammography once every year is a must for women at 50. However,
Indian women get diagnosed with breast cancer a decade before their western
counterparts. So I feel women should get a mammogram done once every two years
after 40. Early mammography has been shown to greatly reduce mortality among
women suffering from breast cancer."
Other experts had a different view.
Dr Vinod Raina, head of medical oncology at AIIMS, said women in high risk
groups like those with denser breast tissue and strong family history of breast
cancer should get themselves screened from 40 years of age.
"However for general screening, Indian women should undergo a mammography once
every two years after they reach 50. This is because the incidence of breast
cancer in India (30 per 100,000 women) is much lesser than in US (100 per
100,000 women) where the problem is acute. Also most women suffering from breast
cancer are identified after 50 because the yield of the mammography machine is
better then. Mammography in India is also expensive, around Rs 1,500 per test,"
Dr Raina said.
Dr Bhavana Sirohi, head of medical oncology at Max Hospital, said the screening
should actually start from age 45. "Indian women attain menopause five years
before the women in the West making the former more susceptible to breast
cancer. That's why women in India should be screened from age 45."
But what experts were unanimous about was that India should start a mass breast
cancer-screening plan like the West under the country's National Cancer
Programme.
Screening mammography rate in India is abysmally low. WHO's latest World Health
Statistics (WHS) said less than 5% women, aged 50-69 years, underwent screening
by mammography in India between 2000-2003.
WHO says there is significant evidence to show that mammography screening among
women in this age group reduces mortality from breast cancer by 15%-25%. Among
women, breast cancer is the most common cause of cancer mortality, accounting
for 16% of cancer deaths globally. Less than a quarter of women globally undergo
breast cancer screening. In India, breast cancer is the most common form of
cancer in women. One in 26 women in India are expected to be diagnosed with
breast cancer in their lifetime, WHO says.
Experts say 50% of breast cancer cases are detected very late in India.
Source : The Times of India
