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

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

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.

CONTENTS
Declaration

Acknowledgement

Abstract

Contents

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

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 lowincome 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
4

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

AIM
(TO CRITICALLY EXAMINE THE
INCIDENCES OF BREAST
CANCER AMONG WOMEN IN
INDIA)

SELECTION OF
STUDY

OBEJCTIVES

BREAST
CANCER
RESEARCH
- WEB RESEARCH

ANALYSIS

- SELF
CONCLUSION

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.

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

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

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.

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

10

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.

11

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.

12

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.

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.

Discharge from the nipples can be caused by many conditions, most of which are
non-cancerous.
13

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.

14

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.

15

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]

16

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.
17

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.

18

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)

19

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.

20

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 highquality 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.

21

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

22

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'.

23

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]

24

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.

25

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.

26

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]

27

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.

28

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 "cando" 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
29

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
30

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.

31

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]

32

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

survey
3%

women who didnt know

about BSE 97%

97%

women knew about BSE 3%

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

33

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

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

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

34

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

SURVEY

6%
women who didnt know
about BSE 94%
women knew about BSE 6%
94%

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

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

35

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

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.

36

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 interest 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 registries 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
37

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 infrastructure 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.

38

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.

39

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

40

COST SAVINGThe 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.

41

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.

42

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

43

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.

44

LIST OF FIGURES:
FIGURE NUMBER
Fig. 1(a)
Fig. 1(b)
Fig. 1(c)
Fig. 1(d)
Fig. 2(a)
Fig. 2(b)
Fig.2(c)
Fig. 2(d)
Fig.2(e)
Fig.2(f)
Fig.2 (g)
Fig. 2(h)
Fig. 3(a)
Fig. 3(b)
Fig. 4(a)
Fig. 4(b)
Fig. 4(c)
Fig. 4(d)
Fig. 4(e)
Fig. 5(a)
Fig. 5(b)
Fig. 5(c)
Fig. 6(a)
Fig. 6(b)
Fig. 6(c)
Fig. 6(d)
Fig. 6(e)

TITLE
Normal Breast Tissues
Cancer Cell Reproduction
lump in breast
Growth of lump
Changes in breast
Position for BSE
Position for BSE
Position for BSE
Checking lump
Lump
Skin changes
Changes in nipple
Increasing risk with age
Risk factors
Incidences and mortality from breast cancer in India, US, and
China
Comparison of incidences and mortality number from breast
cancer between India and US
Data presenting breast cancer incidences in India
Top 10 diseases in Mumbai among women
Number of cancers-female breast in particular year in various
cities of India.
A pink ribbon, an international symbol of breast cancer awareness.
Seminar by HDS NGO, right Christine Hyde (COO of HDS)
Seminar By HDS NGO, Nursing Staff And Me (Devyani Mehta)

Fig. 8(a)

Data collected by survey done in old city area of Udaipur

Old city area Udaipur
Old city area Udaipur
Data Collected By Survey Done In Celebration Mall Of Udaipur
Celebration Mall Of Udaipur
Map Of India Shows The Locations Of The Cancer Registries In
India.
Bamboo structure

Fig. 8(b)

Mammobus Of South India-A Mobile Screening Unit.

Fig. 7(a)

45

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_guidelin
es)
3. http://www.breastcancer.org/symptoms/understand_bc/risk/factors?utm_medium=OB
Widget&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-cancer1764027.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

46