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DECLARATION

I, Devyani mehta, here by solemnly declare that the research work undertaken by me, titled

To critically examine the incidence and treatment of breast cancer among women in India in

comparison to other more developed countries is my original work and wherever I have

incorporated any information in the form of photographs, text, data, maps, drawings, etc. from

different sources, has been duly acknowledged in my report.

This dissertation has been completed under the supervision of the guide allotted to me by the

school.

Devyani mehta V Year B.Arch

Buddha Institute Of Architecture And Town Planning Udaipur

Date: 28-11-2015

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ACKNOWLEDGEMENT

The meaning of adding this page at the beginning of my study for me is much more than just a

clique acknowledgement page.

As this study comes to an end I feel indebted to have the opportunity to express my gratitude to

all those who have lent a helping hand during my endeavor.

I owe immensely to my guides for their invaluable guidance and encouragement given to me

during the entire period.

I am grateful to my faculties, parents a lot and my friends who made it possible in every way,

helped me throughout and provided me with their assistance and constant support during this

study.

Devyani mehta V Year B.Arch

Buddha Institute Of Architecture And Town Planning Udaipur

Date: 28-11-2015

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ABSTRACT

In this study an attempt has been made to study breast cancer incidences. This study critically

examines the incidence and treatment of breast cancer among women in India in comparison to

other more developed countries.

This study will help to find out about the reasons and analyze this within an Indian context.

The main reason for increasing breast cancer is because of lack of awareness among people. The

study includes the reasons behind increasing number of incidence, reasons behind lack of

awareness and promotes solution to the problems being faced by people in understanding

breast cancer and also have some surveys and researches taken on personal level which will help

to find out the awareness among people.

This also includes the basic solution that could be made to help and make people aware about

the problems.

This study promotes awareness and suggests solutions for early detection of the disease of

Breast Cancer in India and its early treatment to reduce the number of unnecessary deaths from

late diagnosis.

A survey has been done to check whether people are aware of the problem or not.

It aims to critically examine the breast cancer detection framework in India.

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CONTENTS

Declaration 1

Acknowledgement 2

Abstract 3

Contents 4

CHAPTER 1 INTRODUCTION ................................................................................................. 5

CHAPTER 2 WHAT IS BREAST CANCER? ........................................................................... 7

CHAPTER 3 SELF BREAST EXAMINATION AND EARLY DETECTION. ...................... 10

CHAPTER 4 BREAST CANCER RISK FACTORS ................................................................ 17

CHAPTER 5 INCIDENCES OF BREAST CANCER IN INDIA ........................................... 23

CHAPTER 6 AWARENESS AMONG PEOPLE .................................................................... 30

CHAPTER 7 RESEARCH AND ANALYSIS ......................................................................... 37

CHAPTER 8 INFRASTRUCTURE ......................................................................................... 40

CHAPTER 9 CONCLUSION................................................................................................... 43

WEBLIOGRAPHY....................................................................................................................... 49

LIST OF FIGURES: ..................................................................................................................... 50

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CHAPTER 1 INTRODUCTION

TOPIC To critically examine the incidence and treatment of breast cancer among women in India in

comparison to other more developed countries.

INTRODUCTION Breast cancer is the top cancer in women both in the developed and the developing world. It is

the most common cancer among women. The incidence of breast cancer is increasing in the

developing world due to increased life expectancy, increased urbanization and some believe due

to adoption of western lifestyles. Although some risk reduction might be achieved with

prevention, these strategies cannot eliminate the majority of breast cancers that develop in low-

income and middle-income countries where breast cancer is diagnosed in very late stages.

Therefore, early detection in order to improve breast cancer outcome and survival remains the

cornerstone of breast cancer control.

It is estimated that worldwide over 508 000 women died in 2011 due to breast cancer. [1]

SELECTION OF STUDY The present study provides a deep insight about the medical facilities in India and its

impact on the population. The present topic has wide gap in theories implied and practical

applications. It has effective scope of analysis. Many researches have been carried out on the

subject and the researcher has developed a wide scope of further researches. Moreover the

topic has attracted my interest and will help me in developing my knowledge in the field. The

research can be used for academic needs or further researches as well.

AIM OF STUDY

To critically examine the breast cancer detection framework in India.

RESEARCH OBJECTIVES To evaluate the statistics involved with breast cancer.

To examine the awareness among the general population about breast cancer.

To determine the impact of good knowledge for early breast cancer detection.

To analyze effective measures to improve knowledge about breast cancer in India.

To evaluate the difficulties faced by the country in reducing the incidences of breast

cancer in India

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SCOPE OF STUDY To highlight the amount of women in Rajasthan, who do not know about the self-breast

examination for detecting the early signs of cancer.

RESEARCH LIMITATIONS The study focuses on developing effective understanding about breast cancer in India and its

impact on the people and health care. The topic has wide scope of analysis however the

limitation of time and resources restricts the in-depth study moreover the research will utilize

both primary and secondary data to evaluate all relevant information related to breast cancer in

India.

RESEARCH METHADOLOGY

BREAST CANCER

AIM (TO CRITICALLY EXAMINE THE

INCIDENCES OF BREAST CANCER AMONG WOMEN IN

INDIA)

SELECTION OF STUDY

ANALYSIS

CONCLUSION

RESEARCH

- WEB RESEARCH

- SELF

OBEJCTIVES

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CHAPTER 2 WHAT IS BREAST CANCER?

WHAT IS BREAST CANCER?

Breast cancer is cancer that develops from breast tissue. Cancer starts when cells begin to grow

out of control. Cells in nearly any part of the body can become cancer, and can spread to other

areas of the body.

Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a

group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to

distant areas of the body. The disease occurs almost entirely in women, but men can get it, too.

The female breast is made up mainly of lobules (milk-producing glands), ducts (tiny tubes that

carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue

surrounding the ducts and lobules, blood vessels, and lymphatic vessels). Most breast cancers

begin in the cells that line the ducts (ductal cancers). Some begin in the cells that line the lobules

(lobular cancers), while a small number start in other tissues.

Figure 1(a) Normal Breast Tissues

Breast cancer starts in the cells of the breast as a group of cancer cells that can then invade

surrounding tissues or spread (metastasize) to other areas of the body.

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Figure 1(b) cancer cell reproduction

Figure 1(c) lump in breast

A Global Burden

According to the World Health Organization, breast cancer is the most common cancer among

women worldwide, claiming the lives of hundreds of thousands of women each year and

affecting countries at all levels of modernization.[2]

WHAT CAUSES CANCER TO DEVELOP?

Cancer begins in the cells which are the basic building blocks that make up tissue. Tissue is found

in the breast and other parts of the body. Sometimes, the process of cell growth goes wrong

and new cells form when the body doesnt need them and old or damaged cells do not die as

they should. When this occurs, a buildup of cells often forms a mass of tissue called lump,

growth or tumor.

Breast cancer occurs when malignant tumors develop in the breast. These cells can spread by

breaking away from the original tumor and entering blood vessels or lymph vessels, which

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branch into tissues throughout the body. When cancer cells travel to other parts of the body and

begin damaging other tissues and organs, the process is called metastasis.

Figure 1(d) growth of lump

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CHAPTER 3 SELF BREAST EXAMINATION AND EARLY DECTECTION

Breast self-examination (BSE) is a screening method used in an attempt to detect early breast

cancer. The method involves the woman herself looking at and feeling each breast for possible

lumps, distortions or swelling. The self-examination technique can detect these early signs of

what may be a cancerous growth and world health organization (WHO) rated as the most cost

effective method of early detection. Breast self-exam (BSE), or regularly examining our breasts

on our own, can be an important way to find a breast cancer early, when it's more likely to be

treated successfully. Not every cancer can be found this way, but it is a critical step to be taken

for betterment.

Breastcancer.org believes that BSE is a useful and essential screening strategy, especially when

used in combination with regular physical exams by a doctor and mammography. About 20% of

the time, breast cancers are found by physical examination rather than by mammography. It is

recommended that all women should routinely perform breast self-exams as a part of their

overall breast cancer screening strategy.

The more you examine your breasts, the more you will learn about them and it is easier to

detect it early.

Early detection is crucial to quality of life

Early detection of breast cancer is crucial not only to the survivorship of a patient, but to her

quality of life while treating the cancer, and thereafter. For many patients, early detection could

mean not having to lose a breast through mastectomy or not having to experience aggressive

chemotherapy, says Dr. Weiss [3]

STEPS FOR PERFORMING BSE (BREAST SELF-EXAMINATION)

It should be a habit of doing breast self-examination once a month to familiarize with how

breasts normally look and feel. Examine within 7 days after the period ends, when the breasts

are least likely to be swollen and tender. The day should be chosen thats easy to remember,

such as the first or last day of the month.

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Picture below shows what a person should look while doing BSE.

Figure 2(a) changes in breast

Following steps should be followed for BSE.

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and

your arms on your hips.

Figure 2(b) position for BSE

Step 2: Now, raise your arms and look for the same changes

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Figure 2(c) position for BSE

Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both

nipples (this could be a watery, milky, or yellow fluid or blood).

Step 4: Next, feel your breasts while lying down, using your right hand to feel your left

breast and then your left hand to feel your right breast. Use a firm, smooth touch with

the first few finger pads of your hand, keeping the fingers flat and together. Use a

circular motion, about the size of a quarter.

Figure 2(d) position for BSE

Step 5: Finally, feel your breasts while you are standing or sitting. It is found that the

easiest way to feel the breasts is when the skin is wet and slippery. Cover your entire

breast, using the same hand movements described in step 4.

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Figure 2(e) checking lump

SIGNS AND SYMPTOMS OF BREAST CANCER

The first noticeable symptom of breast cancer if you dont self-examine regularly is typically

a lump that feels different from the rest of the breast tissue. If treated early enough most cancer

patients can survive. More than 80% of breast cancer cases are discovered when the woman

feels a lump. Even the earliest breast cancers are detected by a mammogram. Lumps found in

lymph nodes located in the armpits can also indicate breast cancer.

A lump in the breast the most common first sign

o The woman usually finds the lump.

Sometimes the lump is seen on a screening mammogram before it can be

felt.

o The lump is present all the time and does not get smaller or go away with the

menstrual cycle.

o The lump may feel like it is attached to the skin or chest wall and cannot be

moved.

o The lump may feel hard, irregular in shape and very different from the rest of the

breast tissue.

o The lump may be tender, but it is usually not painful.

Pain is more often a symptom of a non-cancerous (benign) condition, but

should be checked by a doctor.

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Figure 2(f) lump

Changes in breast shape or size. Skin changes

o The skin of the breast may become dimpled or puckered. A thickening and

dimpling of the skin is sometimes called orange peel skin.

o Redness, swelling and increased warmth (signs that look like an infection) may be

a sign of inflammatory breast cancer.

o Itching of the breast or nipple may be a sign of inflammatory breast cancer.

Itchiness is often not relieved by ointments, creams or other medications.

Figure 2(g) skin changes

Nipple changes

o Some peoples nipples are always pointed inward (inverted). Normal nipples that

suddenly become inverted should be checked by a doctor.

o Discharge from the nipples can be caused by many conditions, most of which are

non-cancerous.

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Discharge from one nipple may be a sign of breast cancer, especially if it

appears without squeezing the nipple and is blood-stained.

Figure 2(h) changes in nipple

LATE SIGNS AND SYMPTOMS

Late signs and symptoms occur as the cancer grows larger or spreads to other parts of the body,

including other organs.

Bone Pain

Nausea

Loss Of Appetite

Weight Loss

Jaundice

Buildup Of Fluid Around The Lungs

o Shortness Of Breath

o Cough

Headache

Double Vision

Muscle Weakness

As with any cancer, early detection and treatment are major factors in determining the

outcome. Breast cancer is easily treated and usually curable when detected in the earliest of

stages.

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CHAPTER 4 BREAST CANCER RISK FACTORS

A risk factor is anything that increases the risk of developing breast cancer. While we do not

yet know exactly what causes breast cancer, we do know that certain risk factors are linked to

the disease. Many of the most important risk factors for breast cancer are beyond control, such

as age, family history, and medical history. However, there are some risk factors which can be

controlled, such as weight, physical activity, and alcohol consumption.

But risk factors dont tell us everything. Having a risk factor, or even several, doesnt mean that a

woman will get breast cancer. Some women who have one or more risk factors but never get

the disease. And most women who do get breast cancer and don't have any risk factors (other

than being a woman and growing older). Some risk factors have a bigger effect than others, and

the risk for breast cancer can change over time because of aging or lifestyle changes.

Although many risk factors may increase the chances of having breast cancer, it is not yet known

just how some of these risk factors cause cells to become cancer. Hormones seem to play a role

in many cases of breast cancer, but just how this happens is not fully understood.

The main predisposing factorcalled risk factorfor breast cancer is age. The older you are,

the greater your chances of developing the disease. Four out of five breast cancers are found in

women over the age of fifty. With a positive family historyhaving a first degree relative such as

a mother, sister, or daughter who had breast cancera womans risk of developing breast

cancer increases. So women with breast cancer should suggest to their close female relatives

that they consult their physicians about their own risk factors, and begin an effective program of

early detection. On the other hand, only about one in twenty cases of breast cancer is truly

hereditarythat is, runs in the familyso not having a relative with breast cancer does not

reduce the womans risk.

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Figure 3(a) increasing risk with age [1]

The above picture shows us the risk of having breast cancer increases according to age. With

increasing age the risk of having breast cancer increases. In India the most common age of

having breast cancer is after menopause I.e. to the women of age 50-60.

One of the risk factors that have a connection to the female hormone estrogen. Fewer

menstrual periods lead to a lower risk. That is probably why women who had one or more

children by the age of thirty are at a lower risk, while women who had an early menarche (first

menstrual period) or a late menopause (last period) are at a higher risk.

Exercise and a low fat diet may have a protective effect, while alcohol intake of more than one

drink per day may increase the risk.

While we dont know exactly what causes breast cancer, we do know that it is not caused by a

blow or a physical injury. The below picture shows some of the risk factors for breast cancer.[4]

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Figure 3(b) risk factors [2]

RISK FACTORS YOU CAN CONTROL

Weight- Being overweight is associated with increased risk of breast cancer, especially for

women after menopause.

Diet- Diet is a suspected risk factor for many types of cancer, including breast cancer, but studies

have yet to show for sure which types of foods increase risk. Its a good idea to restrict sources

of red meat and other animal fats (including dairy fat in cheese, milk, and ice cream), because

they may contain hormones, other growth factors, antibiotics, and pesticides. Some researchers

believe that eating too much cholesterol and other fats are risk factors for cancer, and studies

show that eating a lot of red and/or processed meats is associated with a higher risk of breast

cancer. A low-fat diet rich in fruits and vegetables is generally recommended.

Exercise- Evidence is growing that exercise can reduce breast cancer risk. The American Cancer

Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.

Alcohol consumption- Studies have shown that breast cancer risk increases with the amount of

alcohol a woman drinks. Alcohol can limit your livers ability to control blood levels of the

hormone estrogen, which in turn can increase risk.

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Smoking- Smoking is associated with a small increase in breast cancer risk.

Exposure to estrogen- Because the female hormone estrogen stimulates breast cell growth,

exposure to estrogen over long periods of time, without any breaks, can increase the risk of

breast cancer. Some of these risk factors are under your control, such as:

taking combined hormone replacement therapy (estrogen and progesterone; HRT) for several years or more, or taking estrogen alone for more than 10 years

being overweight

regularly drinking alcohol

Recent oral contraceptive use-Using oral contraceptives (birth control pills) appears to slightly

increase a womans risk for breast cancer, but only for a limited period of time. Women who

stopped using oral contraceptives more than 10 years ago do not appear to have any increased

breast cancer risk.

Stress and anxiety- There is no clear proof that stress and anxiety can increase breast cancer

risk. However, anything done to reduce our stress and to enhance our comfort, joy, and

satisfaction can have a major effect on our quality of life. So-called mindful measures (such as

meditation, yoga, visualization exercises, and prayer) may be valuable additions to our daily or

weekly routine. Some research suggests that these practices can strengthen the immune

system.

RISK FACTORS YOU CANT CONTROL

Gender- Being a woman is the most significant risk factor for developing breast cancer. Although

men can get breast cancer, too, womens breast cells are constantly changing and growing,

mainly due to the activity of the female hormones estrogen and progesterone. This activity puts

them at much greater risk for breast cancer.

Age- Simply growing older is the second biggest risk factor for breast cancer. From age 30 to 39,

the risk is 1 in 228, or .44%. That jumps to 1 in 29, or just under 3.5%, by the time you are in your

60s.

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Family history of breast cancer- If you have a first-degree relative (mother, daughter, sister)

who has had breast cancer, or you have multiple relatives affected by breast or ovarian cancer

(especially before they turned age 50), you could be at higher risk of getting breast cancer.

Personal histories of breast cancer- If one have already been diagnosed with breast cancer, and

then there is risk of developing it again, either in the same breast or the other breast.

Race- White women are slightly more likely to develop breast cancer than are African American

women. Asian, Hispanic, and Native American women have a lower risk of developing and dying

from breast cancer.

Radiation therapy to the chest- Having radiation therapy to the chest area as a child or young

adult as treatment for another cancer significantly increases breast cancer risk. The increase in

risk seems to be highest if the radiation was given while the breasts were still developing (during

the teen years).

Breast cellular changes- Unusual changes in breast cells found during a breast biopsy (removal

of suspicious tissue for examination under a microscope) can be a risk factor for developing

breast cancer. These changes include overgrowth of cells (called hyperplasia) or abnormal

(atypical) appearance.

Exposure to estrogen- Because the female hormone estrogen stimulates breast cell growth,

exposure to estrogen over long periods of time, without any breaks, can increase the risk of

breast cancer. Some of these risk factors are not under our control, such as:

starting menstruation (monthly periods) at a young age (before age 12)

going through menopause (end of monthly cycles) at a late age (after 55)

exposure to estrogens in the environment (such as hormones in meat or pesticides such as

DDT, which produce estrogen-like substances when broken down by the body)

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Pregnancy and breastfeeding- Pregnancy and breastfeeding reduce the overall number of

menstrual cycles in a womans lifetime, and this appears to reduce future breast cancer risk.

Women who have never had a full-term pregnancy, or had their first full-term pregnancy after

age 30, have an increased risk of breast cancer. For women who do have children, breastfeeding

may slightly lower their breast cancer risk, especially if they continue breastfeeding for 1 1/2 to

2 years.

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CHAPTER 5 INCIDENCES OF BREAST CANCER IN INDIA

BACKGROUND

The incidence of breast cancer is low in India, but rising. Breast cancer is the commonest cancer

of urban Indian women and the second commonest in the rural women. Owing to the lack of

awareness of this disease and in absence of a breast cancer screening program, the majority of

breast cancers are diagnosed at a relatively advanced stage. The quality of care available for

breast cancer patients varies widely according to where the patient is treated. The vast majority

of breast cancer patients undergo inadequate and inappropriate treatment due to lack of high-

quality infrastructure and sometimes skills, and above all financial resources. The recent

emphasis on health education, early diagnosis of cancers, and more public facilities for cancer

treatment are expected to bring about the much needed improvement in breast cancer care in

India.

Breast cancer is the most common female cancer worldwide with an estimated 1.38 million

new cancer cases diagnosed in 2008 representing 23% of all cancers in women. It is estimated

that by 2030 the global burden of breast cancer will increase to over 2 million new cases per

year. Furthermore it is estimated that this increase in cases will be largely due to increasing

incidence in developing regions of the world. [4]

INCIDENCES WORLDWIDE

More recently the incidence of breast cancer has been observed to be increasing in low

income countries and data suggests that over the next twenty years the majority of the

increase in the worldwide burden of the disease will be due to rising incidences in these

countries.

A comparison of breast cancer in India with western nations like the US and with our own

neighbor, China, gives a good idea of the trends it is following. This comparison is obtained from

the Globocan Project, the latest of which is for the year 2012. The upper adjoining image gives

an idea about Incidence and Mortality from breast cancer in India, US and China.

The lower adjoining image elaborates the numbers in more detail.

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Figure 4(a) incidences and mortality from breast cancer in India, US and China

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Figure 4(b) comparison of incidences and mortality number from breast cancer between India and US

Both the above images essentially represent the same data. Please read the highlighted

numbers. Concentrate on the following two points:

Incidence means the numbers of women detected with breast cancer in that particular year. The

year in the above images is 2012. So the numbers in 'Incidence' represent the number of women

who were newly detected with breast cancer for the year 2012. They are underlined with a red

line in the column 'count' in the second chart.

Mortality means the numbers of women who died of breast cancer in that particular year. In the

second chart above, the mortality numbers have been highlighted with red arrows in the column

'count'.

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CONCLUSION

For the United States, for the year 2012:

232,714 women were newly detected with breast cancer

43,909 women died of breast cancer

232714 / 43909 = 5.29 = round it off to 5 or 6. So roughly, in the US, for every 5 or 6 women

newly diagnosed with breast cancer, one lady is dying of it.

For India, for the year 2012:

144,937 women were newly detected with breast cancer.

70,218 women died of breast cancer.

144937 / 70218 = 2.06 = round it off to 2. So roughly, in India, for every 2 women newly

diagnosed with breast cancer, one lady is dying of it.[5]

RISING INCIDENCE OF BREAST CANCER IN INDIA

In India, the average age of developing a breast cancer has undergone a significant shift over last

few decades. Cancer is now the second leading cause of death in Indians after cardiovascular

disease.[5] Amongst women cervical cancer is still the most frequently diagnosed cancer but

breast cancer is now the most commonly diagnosed cancer in urban Indian women. The

reasons for the recent observed increase in incidence of breast cancer in the Indian population

are not clearly understood but thought to be changes in reproductive behavior

Please consider the adjoining graph. [6]

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Figure 4(c) data presenting breast cancer incidences in India [3]

The horizontal line lower down represents the age groups: 20 to 30 years, 30 to 40 years and so

on. And the vertical line represents the percentage of cases. The blue color represents the

incidence 25 years back, and maroon color represents the situation today. 25 years back, out of

every 100 breast cancer patients, 2% were in 20 to 30 years age group, 7% were in 30 to 40 and

so on. 69% of the patients were above 50 years of age. Presently, 4% are in 20 to 30 years age

group, 16% are in 30 to 40, 28% are in 40 to 50 age group. So, almost 48% patients are below 50.

An increasing numbers of patients are in the 25 to 40 years of age, and this definitely is a very

disturbing trend.

INCIDENCES IN MAJOR CITIES OF INDIA

Breast cancer is the most common cancer in most cities in India, and 2nd most common in the

rural areas. It is increasing day by day due to various reasons and lack of knowledge among

people .Please look at the following bar graph about percentage distribution of top ten cancers

in females in Mumbai.

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Figure 4(d) top 10 diseases in Mumbai among women

After going through all the graphs, the point worth noting is that, breast cancer accounts for 25% to

32% of all female cancers in all these cities. This implies, practically, one fourth (or even approaching

one thirds) of all female cancer cases are breast cancers in India.

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Figure 4(e) number of cancers-female breast in particular year in various cities of India.

The above figure is showing the number of cancer incidences over the years in different cities

such as- Mumbai(shown with blue color in figure),

Bangalore(yellow),Chennai(brown) ,Tripura(green).this conclude that Mumbai have highest no.

of cancer.

DEATHS BY BREAST CANCER

An estimated 40,430 breast cancer deaths (40,000 women, 430 men) are expected in 2014.

Breast cancer ranks second as a cause of cancer death in women. Death rates for breast cancer

have steadily decreased in women since 1989, with larger decreases in younger women; from

2006 to 2010, rates decreased 3.0% per year in women under 50 years and 1.8% per year in

women 50 and older. The decrease in breast cancer death rates represents improvements in

early detection and treatment, and possibly decreased incidence.[7]

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CHAPTER 6 AWARENESS AMONG PEOPLE

BREAST CANCER AWARENESS MONTH

October is breast cancer awareness month. The Breast Cancer Awareness Month, marked in

countries across the world every October, helps to increase attention and support for the

awareness, early detection and treatment as well as palliative care of this disease.

It is an annual campaign to increase awareness of the disease. While most people are aware of

breast cancer, many forget to take the steps to have a plan to detect the disease in its early

stages and encourage others to do the same.

Breast Cancer Awareness Month was actually founded by AstraZeneca, a drug company that

produces and sells breast cancer treating drugs.

There are about 1.38 million new cases and 458 000 deaths from breast cancer each year (IARC

Globocan, 2008). Breast cancer is by far the most common cancer in women worldwide, both in

the developed and developing countries. In low- and middle-income countries the incidence has

been rising up steadily in the last years due to increase in life expectancy, increase urbanization

and adoption of western lifestyles.

Currently there is not sufficient knowledge on the causes of breast cancer; therefore, early

detection of the disease remains the cornerstone of breast cancer control. When breast

cancer is detected early, and if adequate diagnosis and treatment are available, there is a

good chance that breast cancer can be cured. If detected late, however, curative treatment is

often no longer an option. In such cases, palliative care to relief the suffering of patients and

their families is needed.

The majority of deaths (269 000) occur in low- and middle-income countries, [6] where most

women with breast cancer are diagnosed in late stages due mainly to lack of awareness on

early detection and barriers to health services.

WHO promotes comprehensive breast cancer control programs as part of national cancer

control plans. The recommended early detection strategies for low- and middle-income

countries are aware of early signs and symptoms and screening by clinical breast examination

in demonstration areas. Mammography screening is very costly and is feasible only in

countries with good health infrastructure that can afford a long-term program.

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There are various NGO and groups of people working to creating awareness among people

about breast cancer

PINK RIBBON

Figure 5(a) a pink ribbon, an international symbol of breast cancer awareness.

A pink ribbon is the most prominent symbol of breast cancer awareness. Pink ribbons, which can

be made inexpensively, are sometimes sold as fundraisers. They may be worn to honor those

who have been diagnosed with breast cancer, or to identify products that the manufacturer

would like to sell to consumers that are interested in breast cancerusually white, middle-aged,

middle-class and upper-class, educated women.

The pink ribbon is associated with individual generosity, faith in scientific progress, and a "can-

do" attitude. It encourages consumers to focus on the emotionally appealing ultimate vision of a

cure for breast cancer, rather than on the fraught path between current knowledge and any

future cures.

NEED FOR GREATER AWARENESS

Its important to reflect on the most common cancer in this country.

As the rates will continue to rise, it is critical for women (and men) to understand the risk

factors, signs, symptoms, and methods of early detection for breast cancer. The last of these is

important since the majorities (70%) of Indian women are still being diagnosed in advanced

stages of disease, resulting in high death rates. In the US, more than 90% of breast cancer

patients will survive at least 5 years but the corresponding proportion in India is >60%, and this

is not because our treatments are inferior. [7]We have effective treatments available around the

30

country, and often at subsidized rates for the poorest patients (though access may be difficult).

These delays are mostly due to lack of awareness about the disease, associated symptoms, and

how to detect it early; stigma about having cancer and fear of discrimination towards the

woman and her family; gender inequity whereby women sacrifice their concerns for the needs

of the family; financial concerns about the burden on others, and difficulties and delays in

navigating the health care system. Our researches shows that awareness about breast cancer is

low overall. We need to change this and also to better understand the risk factors for breast

cancer older age, family history, older age at first birth (>30), an earlier age at menarche (< 12

years) and later age at menopause (>55), having no children, oral contraceptive use, shorter

durations of breastfeeding, high alcohol consumption, and being overweight/obese & taller (for

post-menopausal breast cancer) (according to the World Cancer Research Fund, American

Institute for Cancer Research and the WHOs International Agency for Research on Cancer). Its a

common misperception that family history is the most important factor. While it is a strong

factor, it accounts for less than 10% of breast cancer in a population.

Most importantly, early detection methods for breast cancer are available to all women

although lack of awareness prevents most women from accessing these. For women with access

to tertiary care settings, mammography is the gold standard for detecting breast cancer early;

organizations and countries differ on their recommendations for the frequency (every 1-3 years)

and age (40-50 years, depending on if a woman is considered high-risk based on the factors

described above). In India, the average of diagnosis of breast cancer is 10 years younger than in

Western countries.

For all women, there are two other methods (in order of efficacy) the clinical breast exam (to

be conducted by a physician or a trained health professional once a year starting at the age of 20

years) and the breast self-exam (to be conducted by women themselves starting at the age of 20

years monthly, approximately 3 days after the end of the cycle).No matter what your age,

starting in your 20s, you can take matters into your own hands by initiating the right steps

towards early detection of the most common cancer in women, both in India and worldwide.

NATIONAL CANCER CONTROL PROGRAMS BY (WHO)

A national cancer control program is a public health program designed to reduce the number

of cancer cases and deaths and improve quality of life of cancer patients, through the

systematic and equitable implementation of evidence-based strategies for prevention, early

31

detection, diagnosis, treatment, and palliation, making the best use of available resources. A

well-conceived, well-managed national cancer control program lowers cancer incidence and

improves the life of cancer patients.

A comprehensive national cancer program evaluates the various ways to control disease and

implements those that are the most cost-effective and beneficial for the largest part of the

population. It places emphasis on preventing cancers or detecting cases early so that they can

be cured, and provide as much comfort as possible to patients with advanced disease.

AWARENESS SEMINAR

An NGO, HDS (Health and Development Society) from Udaipur (Rajasthan) promotes Breast

Cancer awareness.

HDS held a breast cancer awareness seminar at Rajasthan Hospital Udaipur for the nurses and

staff members on September 11, 2015. The seminar activities involved training to the nurses and

staff members to teach their patients early BSE method. The nurses were also told about the

benefits of breast milk over bottles as part of their Breast is Best Initiative.

During the seminar the staff members were informed about the self-examination method that

could help cut death rates dramatically by detecting Breast Cancer in the very early stages. This

campaign helped the NGO enlighten the nurses the existence of such early detection method.

HDS assured that this information be passed on to other females as well and provided a

laminated 6 point pictorial guide that can be kept for reference purposes.

I myself Devyani Mehta was a part of the seminar for promoting BSE and helped nurses and staff

of hospital to learn and have knowledge about breast cancer. And the seminar was successful as

we ended up providing maximum knowledge to the nurses and trained them to help others to

provide knowledge about self-breast examination.

Details of seminar-

Place Rajasthan hospital, sec.-14, Udaipur (Raj.)

Date - 11- 09- 2015.

Seminar taken on self breast cancer examination

Given by Christine Hyde RGN, Dip HV.

32

Total members participated 10

9 female nurses,1 male staff Nurse

People who knew about BSE 0 Before the seminar

Figure 5(b) seminar by HDS NGO, right Christine Hyde (COO of HDS) [4]

Figure 5(c) seminar by HDS NGO, nursing staff and me (Devyani Mehta) [4]

33

CHAPTER 7 RESEARCH AND ANALYSIS

Various surveys were taken by me (Devyani Mehta) to research about the people having

knowledge about self-breast examination in Udaipur city (Rajasthan).

The survey was taken at two of the very different areas of city, the one was the urbanized area

or the more developed area of city i.e. celebration mall which is situated on NH.8 Bhuwana

Udaipur (Rajasthan). Where the people are more educated and literate compared to the other

area where survey was taken. The second area where survey was held is old city of Udaipur or

the area which is the oldest and is not developed from years.

The aim of the survey was to know the awareness of self-breast examination for cancer within

Udaipur City. About 300 women were surveyed. And the result clearly shows the poor

knowledge among women about breast cancer and awareness about BSE.

The following chart shows the data of survey-

OLD CITY AREA (UDAIPUR, RAJASTHAN)

Total women surveyed 300 women

Women knew about BSE 9 women

Women didnt knew about BSE 291 women

Figure 6(a) data collected by survey done in old city area of Udaipur

97%

3%

survey

women who didnt know about BSE 97%

women knew about BSE 3%

34

Figure 6(b) old city area of Udaipur [4] Figure 6(c) old city area of Udaipur[4]

Survey sheet Date 5th sep , 2015 old city, Udaipur

35

CELEBRATION MALL (UDAIPUR, RAJASTHAN)

The second survey was performed at celebration mall of the city.

Total women surveyed 300

Women knew about BSE 17 women

Women didnt knew about BSE 283 women

Figure 6(d) data collected by survey done in celebration mall of Udaipur

Figure 6(e) celebration mall of Udaipur [4]

94%

6%

SURVEY

women who didnt know about BSE 94%

women knew about BSE 6%

36

Survey sheet Date 12th sep , 2015 celebration mall, Udaipu

CONCLUSION

The number of women having knowledge about BSE is very Low. The survey shows it clearly that

awareness among people is needed very much and they should have proper knowledge about

detecting the disease that may cause a serious problem to people. Various measures should be

taken to make people more aware about breast cancer.

37

CHAPTER 8 INFRASTRUCTURE

The health care burden related to breast cancer in India has been steadily mounting. Over

100,000 new breast cancer patients are estimated to be diagnosed annually in India [8].

Indias medical infrastructure facilities consist of almost 14,000 hospitals, 700,000 specialty

Hospital beds and 500,000 medical professionals. 17,000 medical students graduate every

Year from over 221 medical colleges.[8]

Many specialty oncology centers exist in the major cities which are well equipped with state

Of the art facilities, including spiral CT scanner, gamma cameras, linear accelerator etc. Ethics

Committees have been established in various hospitals to coordinate the ever increasing inter-

est of international and domestic sponsors.

The data collected by population based cancer registries and hospital based cancer registries

are limited. The registries at New Delhi, Mumbai, Chennai, Bangalore, Bhopal, and Barshi are

in the network of Indian Council of Medical Research. Other organizations manage the regis-

tries at Ahmedabad, Aurangabad, Nagpur, Pune, Calcutta, and Karungapally (in figure)

Figure 7(a) map of India shows the locations of the cancer registries in India.

HEALTH SERVICES

Health services in India are delivered by both private and government institutions. The

government institutions consist of 145 medical colleges which are recognized by the Indian

38

Medical Council. Patients have access to free treatment in 104 government institutions across

the country. Most of the cases at these hospitals are malignant in nature and are treated by the

general surgeons.[ 9]

Many of the semi-autonomous and autonomous government hospitals have modern infra-

structure with highly experienced doctors and are thus able to provide patients with world

class treatment at nominal cost. As a result, these hospitals attract large number of patients

from across the country. India has several large public hospitals providing world-class oncology

care at affordable costs.

These hospitals are primarily located in the metro cities and certain Tier-I cities attract large

number of patients from all across the country, thereby providing a ready patient population.

39

CHAPTER 9 CONCLUSION

The study results that the risk factors of getting Breast Cancer is really high among women and

awareness about it is really low. Breast cancer continues to affect a young population and

patients still present late with the advanced disease. Education needs to be intensified. Breast

Cancer occurs a decade earlier in Indian Women as compared with the women of developed

countries and is a leading cause of mortality in developing countries like India,

If we sum up and see breast cancer incidences in India it is noted that-

The Indian population is about 1.15 billion

Number of new breast cancer patients detected 7 lakh

Number of breast cancer patients 2 lakh [10]

Therefore raising awareness about the screening procedure and treatment of Breast cancer can

help reducing mortality.

Since the number of cases are rising, more younger women are getting affected, most are

presenting only after symptoms develop (so usually stage 2B and beyond, rarely earlier stage)

and we cannot prevent this cancer, all we can do is to detect this cancer by early breast

awareness.

There are few solutions that can be done to reduce the number of surgical interventions and

improve survival rates.

1. A BUILDING FOR BREAST CANCER DETECTION TRAINING.

Annex i.e. a small place can be designed in a hospital or in oncology section which helps people

have more knowledge about breast cancer and its treatment. If we talk architecturally the

design should be such that its approachable to the people easily, have a healthy and friendly

environment around it, promotes awareness about breast cancer and its treatment, and relieves

distresses a patients mind.

For example the place could be a caf made of affordable material and cost which helps people

to have a cup of coffee and gain some free knowledge about breast cancer at one place.

40

The above plan is a conceptual layout of an annex that is attached to a main building such as

hospital. The annex may have a common public area with reception desk, a nice stress relieving

place such as a small caf, a doctors consulting room, a training room where women can have

training about BSE and can gain knowledge about breast cancer. The building can be of natural

and light material i.e. bamboo which proves to be a good building material and cheap

comparatively. It also provides great strength as a building or structural material.

Figure 8(a) bamboo structure

41

COST SAVING-

The costs associated with breast cancer treatment and follow-up care can be a financial strain

for some people and their families, even with health insurance. Costs to the health service for

more surgery than would be needed if women were educated in BSE.

Besides the costs of treatments such as surgery or radiation, one may be facing extra expenses

for transportation to and from a treatment center, child care while having treatment, or special

foods to make sure proper nutritional needs are being met. If one have had to take time off from

work and there income is lower, these daily living expenses can be challenging to cover.

If a person don't have insurance or is unemployed, paying for treatment may seem

overwhelming.

Therefore it is noted that to avoid such heavy expenses one should do BSE method to check for

cancer. This is the cheapest way to know about symptoms and check about cancer. In order to

get knowledge and awareness about this methods and techniques a cheap and low cost annex

can be a good solution for people or patients visiting to a hospital. The building will be made of

cheap and low cost building material and the awareness or knowledge given to people will

be cost free.

2. MOBILE TRAINING UNIT

Another cheap and simple solution for reducing breast cancer incidences is mobile training unit.

This is basically a training unit on wheels i.e. a unit which consists of few pamphlets , a visual

information on BSE by a projector , screen and few trained nurse staff or doctors to people

aware about BSE ,causes of breast cancer ,signs and symptoms of breast cancer, and problems

that is faced by a breast cancer patient. This could be a cheap and extremely cost effective

method to educate rural women. The same unit could also be used to teach basic hygiene and

the advantages of breast feeding over bottle feeding.

The main advantage of this unit is it can go place to place and mainly in rural areas to educate

people about breast cancer. This could educate a large number of people at one time.

This unit could have regular visiting day so that women from the surrounding areas would know

when it was due to visit.

42

Figure 8(b) mammobus of south India-a mobile screening unit.[5]

Mammobus is a mobile unit for breast diseases screening. First of its kind in South India, the

Mammobus is a step further to create awareness and make it easily accessible to women

specially from the lower income, straight at their doorstep. The Mammobus is a mobile unit

for breast diseases screening and will be having the following equipments fitted in-

Mammogram - An X-Ray device specially designed for breast cancer screening

Ultra Sound Scanner for the Breast

Audio Visual aids to create awareness

Other necessary kits with competent technicians.

The Mammobus would be stationed in Trichy and travel to urban and rural areas in Rotary

District 3000 covering eight districts, screening women and spreading awareness, especially

on the early detection of Breast Cancer.[11]

BENEFITS OF A MAMMOBUS

Accessibility

The benefit of being mobile is it allows to bring screening services to women at their

place of work or village and this also allows to save more lives.

Convenience

The availability of screening services at the door step brings convenience to participants -

saving them the time, money and hassle of commuting from place to place. Organizers will

also find it convenient to conduct health screening at the comfort of their premises or

desired locations.

43

Comfortable ambience

Mobile services are designed to maximize comfort for the participants while ensuring their

privacy.

Providing service at the doorstep benefits not only the public of the hassle of commuting but

also organizations - with minimum disruption to its operations.

3. GOVERNMENT SPONSORED TELEVISION ADVERTS

Government should help and support people by educating about breast cancer. Government

should take a major step as it did to aware nation for other major increasing diseases such as

smoking, similarly in style to give up smoking campaign steps should be taken to aware people

about breast cancer. Surprisingly breast cancer kills significantly more women than lung cancer

so a campaign of this nature is surely a helpful way to educate people about such a major

problem of breast cancer.

The government of India has taken various steps:

Modi govt. plans care centers to help India battle cancer

Anshu Prakash, principal secretary (health & family welfare) said: "This program aims at

achieving district level permeation. The focus in this program is on oral, breast and cervical

cancers, which are the most common in India".

Sumit Goyal, an oncologist with the Jaypee Hospital in Noida, told IANS: "The government needs

to formulate better programs and strategies, involving the common man and communities so

that benefit can reach everyone."[12]

4. EDUCATION

Education is an important way for spreading awareness about breast cancer. By educating

people they will get more familiar with the disease.. The Breast Health Education Program

empowers women to take control of their health by educating them about their body and

providing important breast cancer resources. In school, colleges and universities students can be

taught about breast cancer and could get training in BSE.

This includes:

In-person training sessions

Materials provided at events

44

Online training module

All the above solutions are cheap and helpful for people and will help so much in educating and

to make people aware about causes and problem of breast cancer. This will help to reduce the

number of incidences and the mortality rate of Indian women.

As a student i have received training in BSE and have passed that knowledge onto my friends

and family.

In this way those who receive training can spread the knowledge wider, saving lives.

45

LIST OF FIGURES:

FIGURE NUMBER TITLE

Fig. 1(a) Normal Breast Tissues Fig. 1(b) Cancer Cell Reproduction

Fig. 1(c) lump in breast

Fig. 1(d) Growth of lump

Fig. 2(a) Changes in breast

Fig. 2(b) Position for BSE

Fig.2(c) Position for BSE

Fig. 2(d) Position for BSE

Fig.2(e) Checking lump

Fig.2(f) Lump

Fig.2 (g) Skin changes

Fig. 2(h) Changes in nipple

Fig. 3(a) Increasing risk with age

Fig. 3(b) Risk factors

Fig. 4(a) Incidences and mortality from breast cancer in India, US, and

China

Fig. 4(b) Comparison of incidences and mortality number from breast

cancer between India and US

Fig. 4(c) Data presenting breast cancer incidences in India

Fig. 4(d) Top 10 diseases in Mumbai among women

Fig. 4(e) Number of cancers-female breast in particular year in various

cities of India.

Fig. 5(a) A pink ribbon, an international symbol of breast cancer awareness.

Fig. 5(b) Seminar by HDS NGO, right Christine Hyde (COO of HDS)

Fig. 5(c) Seminar By HDS NGO, Nursing Staff And Me (Devyani Mehta)

Fig. 6(a) Data collected by survey done in old city area of Udaipur

Fig. 6(b) Old city area Udaipur

Fig. 6(c) Old city area Udaipur

Fig. 6(d) Data Collected By Survey Done In Celebration Mall Of Udaipur Fig. 6(e) Celebration Mall Of Udaipur

Fig. 7(a) Map Of India Shows The Locations Of The Cancer Registries In

India. Fig. 8(a) Bamboo structure

Fig. 8(b) Mammobus Of South India-A Mobile Screening Unit.

46

WEBLIOGRAPHY :

1. Global Health Estimates, WHO 2013 2. Dr. Marisa Weiss, President and Founder of Breastcancer.org

(http://www.breastcancer.org/about_us/press_room/press_releases/2008/bse_guidelines)

3. http://www.breastcancer.org/symptoms/understand_bc/risk/factors?utm_medium=OBWidget&utm_source

4. http://www.breastcancer.org/symptoms/testing/types/self_exam 5. http://www.breastcancerindia.net/statistics/stat_global.html 6. http://www.slideshare.net/prateeksikka/breast-cancer-awareness-campaign 7. http://www.allrajasthan.com/2014/11/breast-cancer.html 8. https://gerson.org/gerpress/pinktober-breast-cancer-awareness/ 9. https://conducting breast cancer/ breast-cancer-awareness/ 10. http://www.breastcancerfoundation.in/breastcancer-india.html 11. http://www.breastcancerfoundation.in/mamobus.html 12. http://www.firstpost.com/india/modi-govt-plans-care-centres-help-india-battle-cancer-

1764027.html

http://www.breastcancerindia.net/statistics/stat_bengaluru.html http://www.breastcancer.org/symptoms/testing/types/self_exam http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931014/

PHOTOGRAPH:

1. http://www.breastcancer.org/symptoms/understand_bc/risk/factors? 2. http://www.breastcancer.org/symptoms/understand_bc/risk/factors?utm_medium=OB

Widget&utm_source 3. http://www.breastcancerindia.net/statistics/stat_global.html 4. Picture taken by Devyani Mehta. 5. http://www.breastcancerfoundation.in/mamobus.html