'In India, even cancer patients don't want to undergo mastectomy'

In India, mastectomy is a big stigma. So much so, even patients who are diagnosed with cancer don’t want to opt for it. They accept it with great difficulty, say doctors.

Pallavi Polanki May 16, 2013 07:36:17 IST
'In India, even cancer patients don't want to undergo mastectomy'

New Delhi: Hollywood actress Angelina Jolie’s decision to go public about having undergone preventive breast cancer surgery has received massive public attention and has been welcomed by women who share her predicament of having a family history of breast cancer.

Risk of breast cancer is a growing worry for women in urban India, given that the number of reported cases has been rising in recent years.

Do doctors in India recommend preventive double mastectomy to patients? And how open are women in India to such a procedure?

Revealing the extent of the stigma attached to mastectomy in India, Deepa Thayal, senior consultant, breast cancer surgery at Delhi’s Fortis La Femme says, “In India, mastectomy is a big stigma. So much so, even patients who are diagnosed with cancer don’t want to opt for it. They accept it with great difficulty. Opting for preventive surgery is, therefore, not something that can happen in the Indian scenario easily. Besides, the feeling among patients is that when they don't have cancer, why go for such an extensive surgery.”

In India even cancer patients dont want to undergo mastectomy

Image used for representational purposee only.Reuters

Single mastectomy could cost between Rs 70,000 to Rs 2 lakh, depending on the hospital, say doctors.

Asked whether the stigma among Indian patients also had to with unstated pressures from the family, Tayal said, “It seems so. Although, none of my patients have has said so to me. In India, women are not always very secure. They are dependent on their families and thus feel more insecure. They tend to believe that this could create problems for them.

“Patients whose families are supportive are a lot more comfortable going in for surgery. And patients where families are not seemingly supportive are more reluctant about their treatment. Patients say, for instance, that they don’t want to go in for chemotherapy for fear of losing their hair. But mostly, the stigma is self-inflicted, it is in the mind of patients.”

The second reason why the procedure was not so well-known, say doctors, is because the gene test –prerequisite for the surgery –was not commonly recommended by doctors in India.

The presence of damaged BRCA1 and BRCA2 gene is associated with higher risk of breast and ovarian cancer. The test doesn’t come cheap and patients have to be thoroughly counselled before undergoing the test. (The cost of gene test varies from lab to lab and according to doctors ranges between Rs 5000 to Rs 20,000).

Rupinder Sekhon, a senior consultant, surgical oncology, at Delhi’s Rajiv Gandhi Cancer Institute & Research Centre, describes the test as being “controversial” because the absence of the damaged BRCA1 and BRCA2 gene doesn’t necessarily rule out the possibility of the patient getting breast or ovarian cancer. “There are some doctors who do not recommend this test at all because it unnecessarily exposes patients to stress. The damaged gene might be there but the patient might not develop the cancer at all and having the  gene doesn’t mean the patient is going develop the cancer,” says Sekhon.

Asked under what circumstances the test was recommend in India, Sekhon said, “We advise this test only in very young patients when they have a strong family history of cancer. In cases where, say, the mothers, the sister, the aunts, have all had cancer. In such situations, we advise doing the test. And there too, it is with certain amount of caution.”

Tayal says presently the test is mostly done if the patient demands it. “Right now, we are doing the test on the patient’s or family’s demand only. If a patient has a strong family history of breast or ovarian cancer, then we advise them to go for BRCA1 and BRCA2 test for first degree relatives,” says Tayal.

On the advice she would give women who were concerned about the risk of breast cancer, Tayal says, “If you don’t have a family history, you could do a preventive screening (mammography) at the age of 35, that is the baseline age. And after 40 years of age, you should go for regular mammography after every two-three years. And patients who have a family history of cancer, should do a mammography every year. Start self-breast examination from the age of 20. And if you should find anything unusual, immediately consult a doctor.”

Prevalence of breast cancer, say doctors, in India is 9-10 percent of population. But the incidence is more among urban than rural India. “In urban India, every 8th woman per 10,000 has chances of developing the disease, while in rural India, every 27th women per 10,000 has chances of developing the disease. The risk is almost three-fold higher in urban population.”

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