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Week of February 18, 2013

Research

Early breast cancer diagnosis, survival rates low in rural India

Women in developed countries survive roughly 10 years longer after a breast cancer diagnosis compared to women in poor-to-middle-income countries, a new U-M study suggests.

The report demonstrates the lack of access to good health care faced by women in poor countries, said the study’s principal investigator Rajesh Balkrishnan, an associate professor at the U-M schools of Pharmacy and Public Health.

Early diagnosis and sustained treatment were the biggest hurdles and also the main indicators of patient survival, he said.

Balkrishnan and colleagues looked at roughly 300 women in the southern rural district of Udupi, India. Patients received one of three chemotherapy drug regimens depending on the stage of cancer. Only about 27 percent of patients were diagnosed in the early stages of cancer, and they survived an average of 11 years. The majority of patients were diagnosed in later or advanced stages, and they survived from about one to two-and-a-half years after diagnosis and treatment.

Many diagnoses occur at later stages because screening isn’t available in those rural areas, Balkrishnan said. Fear, poverty and ignorance about breast cancer also delay treatment and diagnosis. And, if the diagnosis does come early, access and use of breast cancer chemotherapy treatments — even the generic inexpensive options — aren’t readily available. Only the latest-stage patients receive the most current and expensive treatments, he said.

“I think if the tumor is diagnosed early and treated aggressively, a patient can expect an additional decade of survival,” Balkrishnan said. “But access and adherence to optimal treatment remains very difficult for women in poorer countries.”

Breast cancer is a growing problem in India, with estimates as high as one in 22 women predicted to develop the disease. While the breast cancer rate is much higher in the United States at one in eight women, the survival rate is also much higher. For instance, the five-year survival rate for Indian women is about 60 percent; in developed countries, it is 79-85 percent. Additionally, studies have shown that Indian women develop breast cancer roughly a decade earlier than women in Western countries.

There are about 1.4 million new cases of breast cancer worldwide annually, and it comprises 10 percent of all cancers, making it the second most common cancer in the world.

Other researchers included: Daisy Augustine, Anantha Naik Nagappa, Nayanibhirama Udupa and B.M. Vadiraja, all affiliated with Manipal University in India.

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