In a shocking video, Bollywood actor Mahima Chaudhary of Pardes fame revealed that she has been diagnosed with breast cancer. The emotional video which also featured actor Anupam Kher tugged at the heartstrings of many and led to fresh conversations about women's health. But in India, breast cancer remains one of the top afflictions to ail women and many lose their lives to the tumour which often goes undetected until it's too late. Several celebrities, in the last few years such as actors Sonali Bendre, Lisa Ray and singer Kylie Minogue have come out with their journeys of fighting and surviving breast cancer. However, the disease remains one of the top killers of women in India due to a lack of awareness and equitable distribution of healthcare resources, facilities and accessible treatment.?

The numbers are grim

Breast cancer is the most common cancer among Indian women. A 2020 study found that women diagnosed with breast cancer in India have only a 66 per cent survival rate. The same study, conducted by?CONCORD-3,?a global surveillance initiative?for cancer survival, led by the London School of Hygiene and Tropical Medicine, found that survival rates for women in countries like the United States and Australia are nearly 90 per cent.?In 2020, an estimated??7,12,?758 women were diagnosed with breast cancer, as per a report titled 'Cost of breast cancer diagnosis and treatment in India: a scoping review protocol' published in BMJ Journals. That's 104 per 100,000. Data by Indian Against Cancer suggests that for every 2 women newly diagnosed with breast cancer in India,?one woman dies of it.?

While all women of reproductive age are susceptible to the disease, women in cities are more likely to get diagnosed with breast cancer.?In 2020, data showed that?one in every 28 women (1?in?22 urban women and?1 in 60 women in rural India) is?at risk of?developing breast cancer?in her lifetime. Data by the?‘National Cancer Registry Programme’, found that 25–32 per cent of all?cancers among women?were recorded in big cities like Ahmedabad, Bengaluru, Bhopal, Chennai, Delhi, Hyderabad and Kolkata.?

Stigma and lack of awareness

The 2018 CONCORD-3 study on survival rates of women with breast cancer found that the top reason for low survival rates among breast cancer patients in India is the lack of proper awareness about breast cancer. Late diagnosis can be fatal in case of breast case and in India, a majority of cases are diagnosed well beyond the safe period as women continue to be unaware of the signs and symptoms of breast cancer.?

A 2015 study by the National Centre for Biotechnology Information found that?low cancer literacy of breast cancer is a risk factor among Indian women, irrespective of their socio-economic and educational background.?As per the data, about?half (49 per cent)?of the sample size had never?heard of breast cancer.?The study highlighted an urgent need for the nation- and state-wide awareness programmes and emphasises the need to include?multiple stakeholders of the society and the health system. However, a later study in 2018 showed that cancer literacy remained low in India with as many as 90 per cent of women in rural India who were surveyed revealing they had never heard of 'breast cancer'. That's one in three women.?

Stigma regarding women's bodies and women's lack of physical autonomy remains one of the biggest reasons for the lack of breast cancer awareness among women. A 2018 survey by Future Generali Life Insurance Company found that through awareness about breast cancer was high in urban cities, 75 per cent of the women respondents did not go for breast cancer screening and more than 60 per cent of the women found it uncomfortable to talk about breast cancer with family or friends.?

Regular breast cancer screenings are an important part of women's reproductive health. At an initial level, women can check for breast cancer themselves by checking for and identifying lumps or irregularities on their breasts. And yet, a majority of women in both urban and rural areas remain unaware of the simple methods or are uncomfortable performing such tests.?

Unequal access

Further?causes of high incidence and?fatality rates for breast cancer include?the high cost of treatment and lack of adequate screening or treatment facilities. Treatment for breast cancer in India can be anywhere between Rs 2.5 lakh and Rs 20 lakh. Economically backward women from rural areas or even cities are usually unable to bear the hefty cost of treatment. Lack of breast cancer or the high cost of treatment also keeps economically stable women in urban areas from getting breast cancer insurance.?

Need for community-level intervention

In 2017, researchers at the University of Portsmouth in the UK found that traditional marketing campaigns do not work in raising awareness of breast cancer in India,?and that community nurses are the most effective channel. These community nurses, who are trusted in the community and by male members in the family, represent one of the best channels of fostering a greater understanding by men of early symptoms and diagnosis.

These Accredited Social Health Activists (ASHAs) are embedded in the community and are far more effective than national advertising campaigns in overcoming cultural barriers because they have the trust of husbands and fathers as well as the women at risk.

Training of community-level healthcare workers is imperative in increasing awareness of breast cancer. Focusing on making affordable reproductive healthcare across all sections of women in India is also the only way to ensure widespread and equitable access for women.