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A fatal lack of awareness: Breast cancer in India
Indian women attending a breast cancer awareness programme in Jagacha, West Bengal. Image credit: Biswarup Ganguly [CC BY 3.0 (]
Late diagnoses could lead to 76,000 breast cancer deaths a year by 2020, claims a new study.

Breast cancer: Common and deadly

The study, published in the Journal of Business Research, says a lack of awareness surrounding the disease is causing late diagnoses. This increases the risk that, when detected, the cancer is too advanced to treat.

The lack of awareness surrounding breast cancer is despite it being the most common type of cancer among women in India. It is also one of the most common cancers in the country overall, accounting for 14 percent of new cases.

This frequently deadly lack of awareness is being attributed to numerous barriers. Many of these are sociocultural. These include reluctance to consult male doctors; prioritisation of family obligations over health; and an over-reliance on family members for medical advice. 

Urban-rural divide

The study also highlights the divide between rural and urban areas in India. In the case of breast cancer, this divide works two ways. For example, one factor contributing to increasing rates of breast cancer is increased economic development, fostering growing urbanisation. Urban women are more likely to indulge in ‘westernised’ lifestyles, especially in terms of diet, compared to their rural counterparts. These lifestyles place urban women at elevated risks of contracting noncommunicable diseases, such as breast cancer.

Urban women are also more likely to have children later in life, which places them at greater risk of developing cancer, compared to younger mothers. Lower rates of breastfeeding in Indian society is also an issue. Breastfeeding reduces a woman’s risk of several types of cancer, including cancer of the breast, as Health Issues India has reported before.

On the reverse, the impact of breast cancer on rural women is more pronounced in certain ways – one of which is morbidity. This was spotlighted in a separate breast cancer study published earlier this year, which found “mortality-to-incidence ratio was found to be as high as 66 in rural registries whereas as low as 8 in urban registries.”

Limited access to healthcare in rural areas

One explanation for this is that access to healthcare is limited in rural areas compared to urban areas, with major shortfalls in terms of personnel and facilities. Many of India’s rural people are impoverished (despite significant strides in recent decades.) The impetus is often on patients in India to pay healthcare costs out of their own pocket.

This can be viewed as potentially another barrier between breast cancer sufferers and early diagnoses – as well as treatment.

The significant costliness of cancer treatment in India is an issue Health Issues India has previously reported on. Spending by the patient accounts for almost 75 percent of cancer expenditure in India – and the financial, as well as physical, burden cancer, can have may push many already impoverished patients into further destitution. For rural women, who fall further below the poverty line on average than men, this can prevent a particularly harsh state of affairs.

“Willingness to discuss the problem”

The findings of the breast cancer study reinforce the need for a new cultural approach to women’s issues in India. This can only be achieved by increasing awareness through education initiatives, as the study points out. What the authors are keen to note, however, is that the drive to increase awareness cannot fall back on outdated, ineffective methods. Rather, it must emphasise and embrace different ways of reaching out to Indian women.

Using community health nurses, or accredited social health activists (ASHAs) is a good example.  ASHAs are generally trusted more than national advertising campaigns, Judith Fletcher-Brown – one of the study’s co-authors – said. This is due to their visibility in the community and ability to gain the trust of not only the women in question but also their husbands and fathers.

Gaining the trust of men is significant, as it could foster greater openness among families about the need for breast awareness. As Fletcher-Brown notes, “the subject is taboo and rarely discussed within the family, between men and women or even between husband and wife.”

This lack of openness not only applies to families in rural areas, but also in urban environments. Fletcher-Brown adds, “even educated professional women do not discuss private matters about their bodies with their husbands, fathers or brothers.” Therefore, she explains, “it’s essential to direct health messages towards men to increase their awareness of and willingness to discuss the problem.”

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