Breast Cancer In Indian Women – Is It Biologically Different?

Breast Cancer is probably the most widely researched cancer, but most data comes from western countries. This article introduces some of the research work done by me and my colleagues on breast cancer in Indian women, and a few of the differences we were able to show.

In India, cure rates and mortality figures for breast cancer, whenever available, were found to be inferior when compared to western data. This was generally attributed to three factors:

1. Advanced stage of cancer at initial diagnosis, unlike patients in the west who present early.

2. Poorer healthcare access and delivery, compared to more advanced countries.

3. Younger age at diagnosis (due to younger age of the Indian population) when aggressive tumors are more common.

However, in addition to the above reasons, is there a possibility that breast cancers in Indian women are different from their western counterparts, and if so, shouldn’t treatment be more tailored to suit them? This is a question many Indian researchers have been asking over the past few decades.

In 2006, my clinical team at the Department of Surgical Oncology, St. John’s Medical College Hospital, along with our research team at the St. John’s Research Institute, started a project (still ongoing!) where we prospectively started collecting high-quality clinical data as well as tissue samples from patients of breast cancer. We provided the current best standard of care treatment to all these patients. We started a breast cancer support group, and had a dedicated clinical psychologist who served as counselor, coordinator, and point of contact for all these patients. Our follow-up rate (number of patients still in close touch with us) over many years is a phenomenal 98% (link to the paper on how we achieved this). This rate of follow-up is extremely difficult to achieve in the Indian setting, and we are grateful to the good work and patience of our clinical psychologist for this achievement.

We also stored the tissue samples in ways unique at the time (including storage at low sub-zero temperatures), which meant that we could access samples of tissue and analyze them in ways not possible with tissues stored in regular paraffin blocks.

The longitudinal follow-up of hundreds of patients over many years, and various studies (pathological, molecular, genomic) on tissue samples provided us with a lot of research material, many of which were available for the first time in the setting of Indian breast cancer patients.

Among the dozens of studies that we published, one of the early ones was a paper we brought out in 2011, which led to me being offered a fellowship to the Detroit Medical Center, Michigan.

In this study, we clearly showed that even when we account for factors like the younger age of our patients, later stage at diagnosis, and technical shortcomings, Indian women do tend to have a higher likelihood of developing certain variants of breast cancer which are inherently more aggressive.

For those interested, here is the link to the full paper:

Manjunath Suraj et al. “Estrogen Receptor Negative Breast Cancer in India: Do We Really Have Higher Burden of this Subtype?.” Indian journal of surgical oncology vol. 2,2 (2011): 122-5.

This paper and many others both by our team and other researchers show that we need to better understand breast cancer in Indian women.  This will enable us to prognosticate and perhaps treat our patients better.

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