Sharing Breast Cancer Advances with India
In honor of Breast Cancer Awareness Month, throughout October we’ll be posting a series of stories about breast cancer prevention, treatment and survivors.
Mamatha Chivukula, M.D., is a breast cancer pathologist at Mills-Peninsula Health Services, located in one of the most medically sophisticated regions of one of the most medically advanced nations in the world.
She knows that testing the molecular structure of a tumor can save some women from unnecessary chemotherapy. She knows that some women with high-risk lesions can prevent breast cancer from ever developing if they take tamoxifen preventatively.
Yet she also knows that most women with breast cancer in her home country, India, will die from breast cancer, because the advances we take for granted in the U.S. aren’t widely available there.
“It’s been my dream to try to bridge that gap,” says Dr. Chivukula, also a Clinical Associate Professor at the Magee Women’s Hospital, University of Pittsburgh Medical Center.
Recently, she organized and helped lead The First International Breast Cancer Symposium 2013, held in Bangalore, India. “We have such established criteria and guidelines in the U.S. that really do save lives. We wanted to try to bring more uniformity of practice to India as well.”
The symposium focused on identifying high-risk lesions that put women at risk for breast cancer, and on testing tumors to learn which drugs would fight them most successfully. The next step, she says, will be much more difficult: to raise awareness and increase breast cancer screening among Indian women.
Challenges for Early Detection
Breast cancer is increasing among Indian women, and nearly all cases are diagnosed after the cancer has metastasized, when it is much more difficult to treat. In India, there are no national screening programs. Women who want to have a mammogram must go to a private hospital and pay for it out-of-pocket.
“There are huge challenges in early detection, both financially and in awareness,” says Dr. Chivukula. “Rural, poor women are afraid to talk about their cancer. Even if they notice some changes in their breasts, they’re not going to talk to a doctor. And if they are diagnosed, they may never go in for follow-up treatment.”
Adding to the challenges, nearly half of Indian women have a type of breast cancer that’s uncommon in the U.S., triple negative breast cancer. That means the cancer doesn’t respond to the hormones estrogen and progesterone, or to a protein called HER2. Triple negative breast cancer is harder to treat, and more common in women who have BRCA1 genetic mutations. Dr. Chivukula thinks research may eventually find that Indian women have a high prevalence of BRCA mutations, similar to Jewish people of Ashkenazi descent.
“In order to get political and financial support for widespread early screening, we need to have incidence data on Indian women,” says Dr. Chivukula. “We have to start looking into our genes and know our BRCA incidence rates, so we can help the next generation of Indian women. With my education, I hope to help get that started.”