Dr. Indraneel Mittra - Breast Cancer in India

Respected Brother,

Sadar Charan Sparsh,
I remember having mentioned of Dr. Indraneel Mittra, FRCS, as an acquaintance from Anand Bhavan Days! Here for the larger benefit of fellow bloggers I copy paste a popular article by him on the Breast Cancer in India. I probably may not have time to translate it into Hindi. Now language does play an important role in a country’s progress! The great pain and strain Dr. Bachchan took during his assignment in Ministry of External affairs to promote Hindi fell on deaf ears and unwilling and non-co-operative bureaucrats.

Now you talk of your blogs being made available in all the national languages! we are stupid people! We do not have one single national language and we talk of promoting 15 langauges as belonging to us! Language is meant to unite ad not divide the country. The greatest fallacy of modern India that was committed inadvertently by our first home minister Sardar Vallabh Bhai Patel was the division of India on the basis of language.

One has to be honest to oneself if so many national languages could really take us forward or backward! I for one would agree to even forget Hindi as a national langauage as it is not acceptable to many a states who have not only shown reservations but also opposed the implementation of Hndi at a national level.

I am personally convinced that British were kind to us by virtue of providing us a common language in English where we could unite ourselves and evolve into a free nation! No, I am not sounding pessimist, I am an optimist by all means and I have no reservations in upholding English as the national or even an international language only French, German, China, Russia would not submit to my idea of acceptance of English as the most dominat language on the earth! Yet they too get their share of prvalent English in almost every sphere of life! They can deny English to be thrusted upon them as they probably have a language tha they consider their own and not 15 languages that we boast of as national languages.

I have nothing against any of the 15 languages but anyone please don’t tell me that Kashmiri, Assamese, Nepali and Oriya could come anywhere close to the status of national languages. Every community has a right to protect and promote the language they speak, only that they should not demand a national status for the same for the heck of it. They should try to understand as to what can and shall be considered as NATIONAL.

Here I consider Dr. Indraeel Mittra a national hero who has achieved great fame in his field of research on breast cancer. I am afraid he would not say that he would take much notice as to make his article available in Bangla or Hindi, though it is quite important. Imagine if we have to translate such important articles which can run into thousands into 15 langauages, what a sheer waste of time, energy and space that would be!

Without holding all of you in this ugly langauge debate I should transfer you to he article by Dr. Mittra. Someday if we have one national language we could probably look forward to put all our great works in that language. As of today, I am afriad India does not have a national langauge of its own!

Professor Indraneel Mittra

Professor of Surgery and Consultant Surgeon and Scientist,

Tata Memorial Hospital, Mumbai

( The article was written in 2001, yet it would serve as broad guidelines for us Indians!)

The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. This is because more and more women in India are beginning to work outside their homes which allows the various risk factors of breast cancer to come into play. These include late age at first childbirth, fewer children and shorter duration of breast-feeding. Of these, the first is the most important. In addition, early age at menarche and late age at menopause add to the risk to some extent. Family history of breast cancer increases the risk as follows: if a woman has a mother who has suffered from breast cancer her risk increases about 3 fold while having a sister with cancer, the risk increases by about 2-3 fold. About 5% of breast cancers are hereditary, i.e. due to a gene being transmitted either from the father or from the mother. Typically, these families have many members who fall victim to the disease, which tends to occur at a relatively young age and often affects both breasts. Two genes namely BRCA1 and BRCA2 have been identified although genetic testing, because of ethical, emotional and social implications that they carry, is still in the sphere of research in most developed countries except the U.S. Thankfully, the incidence of breast cancer is much lower in India compared to western countries. The incidence varies between urban and rural women; the incidence in Mumbai is about 27 new cases per 100,000 women per year while in rural Maharashtra it is only 8 per 100,000. The chances of cure in women who develop the disease is related to early diagnosis. There are 3 methods for early detection of breast cancer. Mammography i.e. X-ray of the breast, done at regular intervals, say every 2 years, is popular in the west. However, mammography is expensive, technology driven and requires stringent quality control and extensive experience on the part of technicians and doctors involved. If these are not available, mammography can do more harm than good by falsely diagnosing cancer or missing it when it is actually present. I would personally recommend mammography only in women who have a family history of breast cancer or other risk factors. The second method is for a woman to get herself examined clinically be a breast specialist. It appears that if clinical examination is done properly it may be as effective as mammography. The third method is self-examination whereby a woman examines her own breasts once a month after taking lessons from an expert. Many women however do not like doing self-examination often out of fear of finding cancer. Nevertheless evidence suggests that if the examination is done properly and regularly, it may help to detect breast cancer early. Typically, breast cancer arises from cells lining the milk ducts and slowly grows into a lump. It is thought that it takes about 10 years for a tumour to become 1 cm in size starting from a single cell. Once breast cancer develops, surgery is the usual treatment. If detected early enough, the breast can be conserved by removal of the lump alone without a mastectomy. In this case, the glands in the armpit are also removed. This treatment is followed by radiotherapy to the breast. Chemotherapy is usually given as an adjunct to surgery to kill any stray cells that might have escaped and lodged elsewhere. Anti-oestrogen drugs are also used very effectively in women whose tumours are responsive to hormones. The latter is determined by a laboratory test called oestrogen receptor test. Sometimes chemotherapy is given first to reduce the size of the tumour so that breast conserving surgery can be performed. Once breast cancer spreads to other organs the disease usually becomes incurable and the treatment is directed at relieving symptoms, if any. Nevertheless, much can be achieved with treatment by anti-hormone medications as well as chemotherapy and radiotherapy. Many young women experience pain in their breasts, especially before their periods. Pain in the breast is usually not related to cancer and often settles down on its own. If severe, painkillers can be taken. Pain in the breast is rare after menopause. Many women have lumpy breasts which in medical jargon is called “fibroadenosis”. This again is not a precursor of cancer. Lumps in the breast in premenopausal women may sometime be caused by cysts containing fluid. This can be aspirated with a needle which usually cures the condition. Younger women sometimes have solid non-cancerous lumps called “fibroadenoma” which usually requires removal under local anaesthesia. Discharge from the nipple is not uncommon, but if it is bloody, this may sometimes indicate the presence of early cancer. To conclude, do not ignore a lump in the breast – see a doctor.