Why breast cancer detection tools fall short for young Indian women

India made a Guinness World Record with 994,349 online breast cancer screening sign-ups in one week, announced Union Health Minister JP Nadda late last week.

However, breast cancer cases are surging among women in their late 20s, which is nearly a decade earlier than in the West, and six in 10 diagnoses occur at stage 3 or 4. This signals that breast cancer screening for young women remains a concern.

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While mammography is the gold standard for screening, it falters in younger women with dense breasts, emphasising the need for other screening and diagnostic solutions. Even though several methods, such as radiation-free thermal imaging, portable ultrasound devices, and liquid biopsies that detect cancer pre-lump via blood, are considered viable options, the detection remains a challenge for young women.

This is mainly due to the limited availability of scientific evidence for these newer methods and the lack of access to these facilities.

High risk, big challenge

Dr Veda Padma Priya, Clinical Lead and Senior Consultant of Breast Oncology at MGM Cancer Institute, told The Federal, "Breast cancer in young women, who are below 40, is becoming common in India. In fact, it is double the number in Western countries. For instance, in the West, approximately 7 per cent of women diagnosed with breast cancer are below 40. In India, it's 15 per cent".

Doctors say the challenges are multifarious. For one, breast cancer is not amenable to screening mammograms in younger women. For another, these women tend to have larger tumours at diagnosis since they have firmer breasts, and so it's easy to miss out on lumps.

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"Being young, they might not have planned a family or had children, and hence, fertility preservation is a major concern. Younger women should do a breast self-examination once a month, one week after menstruation, to pick up early changes in the breast. It is important to do a pedigree analysis to look into hereditary cancers since a strong family history increases your risk for breast cancer. Imaging diagnostic procedures, such as yearly breast ultrasound, help in young women. If it is a high risk, then mammograms and MRI need to be done additionally," said Dr Veda.

Not a post-40 disease anymore

There is a need to evolve — and ensure access to — screening tools that can screen and diagnose breast cancer at an early stage.

Dr Nithya Sridharan, Associate Director and Senior Consultant Medical Oncologist at VS Hospitals, emphasises the need for evolved modalities for breast cancer screening.

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She told The Federal, "I have been seeing more women in their late 20s and early 30s coming in with breast cancer. It’s worrying because we used to call it a post-40 disease. Our screening tools need to evolve with these changing realities. Mammograms are still our gold standard, but they struggle to pick up changes in dense young breast tissue."

Dr Sridharan explained that newer, non-invasive options are available for early detection if any signs are noted. "There are portable ultrasounds, thermal imaging, and even liquid biopsies that can trace cancer signals in blood before a lump appears. These are not replacements but important companions in early detection. Technology will help, yes, but what truly saves lives is awareness. Most young women don’t think breast checks apply to them. It is important to act early so there can be better protection and early treatment," she added.

Major drawbacks

However, there are limitations to these newer technologies in screening as well. Dr Manjula Rao, Consultant of Breast Oncoplastic Surgery at Apollo Proton Cancer Centre, told The Federal that the newer modalities in the market, such as thermographic screening and liquid biopsies, are not recommended for routine screening.

"They are not specific and can lead to confusion. Many other new modalities do not have adequate scientific evidence in support of their use in screening," she noted.

In this backdrop, self-examination of breasts becomes paramount. Younger women should go for monthly self-breast examinations and a breast clinical check-up by their doctors once a year, said Dr Rao.

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"While routine annual breast cancer screening by mammography is recommended for all women of 40 and over, those under 40 years need to see the doctor for a breast health check once a year. In case of any suspicion of abnormality, doctors may ask for an ultrasound of the breast and, if required, an MRI of the breast. All women 18 years of age and over are advised to make monthly self-breast examination a habit. It helps the woman be mindful of the normal state of her breast, which would alert her in case of any sudden changes," she added.

Still lacking

Meanwhile, newer modalities of screening are not yet incorporated in the public health screening programmes.

The Tamil Nadu Health Department is offering organised cancer screening programmes under the National Health Mission (NHM) for common cancers, including breast cancer. While the programme screens individuals aged 30 and above, provides treatment, and offers counselling for lifestyle modifications, they do not have any methods to screen younger women.

"There are new technologies that are being adopted for the screening, but the same is a challenge to perform for younger women using mammograms. Moreover, access to these technologies is limited in the public health sector," said a retired official from the state health department.