he burden of breast cancer on small-town India is set to emerge as the next big concern. The difference in the incidence rate of breast cancer among pre-menopausal women in metropolitan cities and towns has shrunk, and in some cases smaller cities such as Wardha and Bhopal have recorded a higher incidence than metros like Mumbai and New Delhi among women in the under-45 age group. However, breast cancer incidence among post-menopausal women remains much higher in urban areas and is also three times the numbers in younger women.
The 2009-11 data from the 26 cancer registries, the last published data of the National Cancer Registry Programme, from across the country show cities like Nagpur, Thiruvananthapuram and Kamrup urban district in Assam recording a higher breast cancer incidence (in the under-45 age group) than Mumbai, Bengaluru and New Delhi. Among major cities, Nagpur has the highest breast cancer incidence among pre-menopausal women.
The small-town surgeA study on ‘Rural urban differences in breast cancer in India’, published in the Indian Journal of Cancer , uses this data, and focusses on the bigger concern — that of a large number of 45-plus women in urban areas who are afflicted with breast cancer — to analyse how one’s area of residence can add to or reduce the risk of cancer. Doctors say the pre-menopausal data cannot be described as a trend just yet, but they do point at smaller towns going the way of big cities. “Pre-menopausal risk factors are not only environmental, but could also be genetic,” says Dr. Rajesh Dikshit, professor at the Department of Epidemiology, Tata Memorial Centre (TMC), which carried out the study.
In the post-menopausal category, cities like Bhopal and Nagpur have recorded higher breast cancer incidence rates than Pune.
For both young and old age groups put together, cities like Thiruvananthapuram, Aizawl and Nagpur have a higher breast cancer incidence rate than Mumbai. The highest breast cancer incidence is recorded in Bengaluru.
Since pre- and post-menopausal figures are in small subsets, they do not give the complete picture, says Dr. Rajendra Badwe, director, TMC. “A majority of the mid-sized towns are on the same road as metropolitan India,” he says of the increasing incidence in smaller cities, adding that urbanisation-related trends of obesity, late first child and less breastfeeding can now be seen in these towns as well.
But rural India remains largely healthy, the study notes: “Women living for many years in rural areas adhere to lifestyles which are protective against breast cancer… Protection was observed in women currently living in rural areas compared to women who have never lived in a rural area. Furthermore, residence in the first 20 years of life in rural areas was observed to be a protective factor against breast cancer.”
roli.srivastava@thehindu.co.in
