In an interview with ETHealthworld, Dr T S Sridhar, Head, Division of Molecular Medicine, St John's Research Institute, Bengaluru, talks about his understanding and approach towards breast cancer management. Edited excerpts:
Please share your understanding of breast cancer in India and how it differs from that of the West?
My interest in breast cancer has been over the last 10 years and it arose from a common refrain I heard when I returned to India after having finished my training in the US, which was that breast cancer in Indian women is different from breast cancer in Caucasians western women.
While at the face of it this seemed to be true, we wanted to understand this at three different levels as to what the differences were due to the cultural differences between India and the west. Next was the demographic difference. India is a very young country versus the western populations and third and most importantly from the point of view of treatment whether there were real biological differences between the breast cancer in India women versus the western so that is what got us started about 100 years ago.
How is your approach to breast cancer different from others?
We started off by establishing breast cancer support group called the Adhara which was manned by young trained medical counsellors who were able to first meet with the patient and their family, establish a rapport and get to know the social economic background in which these women were embedded, and then get to know their actual challenges in going through the treatment.
We then work very closely with the pathologists and then the medical doctors. The most important thing is that we stayed in touch with these patients. Our approach was socio cultural, demographic as well as the biologic differences in breast cancer in Indian women compared to what we already knew about breast cancer in western women.
It was known that breast cancer in India happens on an average of about 10 years earlier than breast cancer in western women. It is about 60 years the median means half of all women with breast cancer in the west have it after the age of 60 and in India it is a decade earlier which is 50. So, half of all women in India are under the age of fifty.
We confirmed the finding and in India it is actually happening earlier. But, if you look at the demographics of US - the nation where I worked and for which I know the statistics, the median age of women in the US is a little after 35 and if you look at the median age of Indian women it is now about 28 years, so the population itself is left shifted, meaning we are a younger population.
We have far more younger women compared to the west and so the demographics is part of it. Socio-cultural norm that doesn’t not allow a women to speak about a lump in her breast have actually been persistent despite being exposed to higher education. It is truly a cultural problem and the way to deal with this obviously as a consequence is to attack it at its roots
Is Indian breast cancer more aggressive in nature?
Whether the tumour was ER negative or ER positive, its behaviour was independent of ethnicity. An ER positive tumour in western woman, Asian woman, Japanese woman or an Indian woman behaves the same way. So because we have more ER negative tumours they think Indian breast cancer is more aggressive which is not correct. Breast cancer aggression is related to its biology, if it is ER negative it is more aggressive and if it is ER positive it is more manageable. So that was a very important thing that we established.
Third thing that we found was most of the patients were treated with standard surgery radiation and chemotherapy. In the general ward all of this adds up to about 2-3 lakh rupees in Bangalore today in a private setup. The outcome of all treated patients if they come to the doctor early, meaning before stage one and stage two, they are now doing just as well as people treated anywhere else in the world.
Impact of your research?
Our research has not directly impacted patient care in the short run however what we have done because we did the molecular genetic analysis of these tumours, we have developed certain tests which now permit us to put these women into categories, subcategorize them, people who might respond to one therapy better than the other and who might have a propensity for the disease to spread. These tests are actually in development and it is likely that they will be available for patients.