A Growing Concern

Breast cancer is now the most commonly diagnosed cancer among Indian women, surpassing cervical cancer in recent years. The GLOBOCAN 2020 report revealed that India recorded over 178,000 new breast cancer cases and more than 90,000 deaths, making it a public health crisis in the making. In Delhi/NCR, a region that uniquely combines advanced urban settlements with semi-urban and rural belts, the impact of this disease is amplified by stark differences in lifestyle, access to healthcare, and awareness.

The Urban vs. Rural Reality

Urban areas in Delhi/NCR show a higher reported incidence of breast cancer, largely due to a combination of delayed childbirth, sedentary work environments, increasing levels of obesity, and dietary habits dominated by processed foods. Women in urban spaces often have better access to diagnostic facilities, yet are simultaneously exposed to risk factors such as environmental pollutants, chronic stress, and hormonal therapies.

In contrast, the rural population reflects a paradox. On one hand, recorded incidence rates are lower, which might seem promising. However, these figures are often misleading due to underdiagnosis, lack of awareness, and cultural stigmas that prevent women from seeking timely medical care. Women in rural Delhi/NCR are more likely to ignore symptoms or delay medical consultation, influenced by limited healthcare infrastructure and financial constraints. A 2022 study by AIIMS indicated that over 60% of rural women in North India have never undergone even a basic clinical breast examination.

The Lifestyle Factor

One of the most critical influences on breast cancer risk is lifestyle. Urban women in Delhi experience higher levels of physical inactivity due to desk-bound jobs and increasing reliance on technology. According to NFHS-5 (2019–21), more than 23% of urban women in the city are overweight or obese—a significant risk factor for hormone-related cancers. Alcohol consumption and stress are also emerging threats in metropolitan areas, with studies such as The Lancet Oncology’s 2020 India report linking alcohol use to nearly 6% of breast cancer cases. Additionally, a 2023 survey by Fortis Healthcare revealed that over 70% of working women in major Indian cities, including Delhi, report high levels of stress—often overlooked in public health planning.

On the other hand, while rural lifestyles may appear physically active, they are not immune to risk. Poor nutrition, lack of reproductive health education, and delayed access to preventive care all contribute to late-stage cancer diagnosis, which significantly lowers survival rates.

Access, Awareness, and Equity

The disparity between urban and rural breast cancer outcomes highlights a critical urban-rural health inequity. While urban women benefit from screening programs, health insurance coverage, and frequent media campaigns, rural communities continue to struggle with limited infrastructure, social stigma, and misinformation. Breast self-examination (BSE), a simple and effective tool for early detection, remains poorly understood or practiced in rural areas. A 2021 study conducted by PGIMER, Chandigarh, found that fewer than 25% of rural women in North India were aware of BSE or its importance.

Moreover, despite Delhi’s status as a healthcare hub, a significant portion of its rural outskirts remains underserved. The gap in access to diagnostics and follow-up treatment further exacerbates health outcomes for women in these areas.

Toward Inclusive Solutions

Closing the gap in breast cancer awareness and care in Delhi/NCR requires a multipronged approach. Community-based screening through mobile mammography units can play a transformative role in rural areas. Public health programs must include culturally sensitive awareness campaigns that speak to women in their local languages and address social taboos directly. Simultaneously, wellness initiatives in urban areas need to prioritize stress management, dietary counseling, and regular health check-ups.

Education plays a foundational role. Integrating reproductive health and cancer awareness in school and college curricula can empower young women early in life. Strengthening the role of Accredited Social Health Activists (ASHAs) and local healthcare providers is also essential in spreading awareness and building trust within rural communities.

A Data-Driven Call to Action

Data paints a sobering picture. Nationally, one in 29 women is at risk of developing breast cancer in her lifetime. In Delhi/NCR, this risk is even more pronounced. Yet nearly 60 to 70 percent of breast cancer cases across India are detected in advanced stages, significantly reducing survival chances. In contrast, early-stage diagnosis can increase the five-year survival rate to over 90 percent, emphasizing the life-saving potential of awareness and timely intervention.

Breast cancer in Delhi/NCR is a mirror reflecting the broader challenges of India’s healthcare landscape—a landscape shaped by geography, income, education, and gender. To truly combat this disease, we must move beyond hospital-centric solutions and invest in community engagement, preventive education, and equitable access to care.

Empowering women—urban and rural alike—with knowledge, support, and timely medical attention is not just a health goal; it is a societal necessity. In doing so, we not only improve survival rates but also affirm the right to health and dignity for every woman, regardless of her postcode.

Authors Biography

Shilpi Bariar is Research Scholar at Amity Institute of Social Sciences & Dr. Roumi Deb is Professor at Amity Institute of Social Sciences Amity University Noida

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Women’s health today is moving beyond the era of one-size-fits-all checklists. For decades, screenings relied largely on age brackets or generalized guidelines, often overlooking the nuances of each woman’s unique health journey. Advances in imaging technologies and laboratory testing now allow for a far more personalized approach—catching conditions earlier, tailoring treatments, and improving outcomes significantly.

Detecting the Silent Shifts Early

Breast cancer offers one of the clearest examples of why early and precise diagnostics are crucial. With millions of new cases diagnosed globally each year, timely detection often marks the difference between conservative management and aggressive treatment. Digital mammography, especially when paired with 3D tomosynthesis, can now identify changes as small as 50 microns, dramatically improving survival rates. For women with dense breast tissue or a strong family history, combining mammography with ultrasound or MRI provides a safety net against missed diagnoses.

The same applies to other silent conditions. Pelvic ultrasound, often associated only with pregnancy, also reveals early signs of ovarian cysts, fibroids, and endometriosis—conditions that can threaten fertility or cause chronic pain if undetected. Identifying these concerns early opens up a wider range of options, from lifestyle adjustments and medications to minimally invasive procedures, before more severe interventions become necessary.

Looking Beyond Symptoms

Personalized diagnostics extends far beyond imaging. Hormonal and metabolic profiling, for instance, offers a window into underlying imbalances that may not present obvious symptoms. Comprehensive hormone panels measuring estradiol, progesterone, AMH, thyroid hormones, FSH, LH, prolactin, and cortisol can uncover early signs of PCOS, thyroid dysfunction, or adrenal imbalances years before they appear clinically. Acting proactively on these results allows preventive care, reducing long-term risks.

Bone health is another area where early diagnostics make a difference. Conditions like osteopenia and osteoporosis typically remain hidden until a fracture occurs. A DEXA scan can detect bone density loss early, especially vital for women approaching menopause or those with metabolic or thyroid-related conditions. Similarly, thyroid screenings often expose subclinical hypothyroidism—an invisible condition that quietly affects fertility, energy levels, and cardiovascular health.

Cervical cancer screening provides yet another example of the life-saving impact of diagnostics. Regular Pap smears, combined with HPV testing, detect pre-cancerous changes well before they become invasive, turning what was once a life-threatening disease into a largely preventable one.

Towards Better Outcomes

What makes personalized diagnostics transformative is not simply the array of tests available, but how they are combined and interpreted in the context of an individual woman’s risk profile. Rather than waiting for symptoms to surface, physicians are increasingly using family history, genetics, hormonal balance, and lifestyle factors to shape care pathways. This ensures higher-risk women are screened earlier and more intensively, while unnecessary testing is minimized for others.

The patient experience is also being redefined. Integrated workflows that combine imaging, pathology, and molecular testing reduce delays and uncertainty. Convenience features like home sample collection, digital reports, and online scheduling further encourage consistency in health checks—helping women prioritize their well-being without disruption.

The result is a healthcare system that identifies disease earlier, offers more precise interventions, and empowers women with clear, individualized insights. Personalized diagnostics does not replace existing guidelines; instead, it enhances them, ensuring care is both evidence-based and uniquely tailored.

Key Takeaway

Personalized diagnostics is reshaping women’s healthcare. By moving beyond generic screening models and aligning tests with each woman’s specific risk factors, it enables earlier detection, more targeted interventions, and greater preventive care. As access and awareness continue to expand, this approach offers women the ability to take charge of their health sooner, avoid complications, and build a stronger foundation for lifelong well-being.

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Both vigorous and moderate physical activity are beneficial to health.

R- Rest Adequately:

Overall, getting enough sleep is essential for preserving our health and wellbeing. Rest aids in preventing injuries and enhancing performance by giving our bodies time to heal. Additionally, it promotes a healthy immune system, eases inflammation, and helps muscles rebuild themselves. Additionally, getting enough sleep lowers stress. Rest means getting enough sleep. A solid 7 to 8 hour sleep cycle is crucial.

E – Eat Healthy:

A range of healthful meals are part of an eating regimen that supports weight management and overall health. Consider adding a variety of colours to your plate as if you were eating the rainbow. Dark, leafy greens, oranges, tomatoes, even fresh herbs, are all incredibly nutrient-dense foods.

A – Avoid Birth Control Pills if possible:

Birth control pill use, whether recent or current, has been demonstrated to slightly increase the risk of breast cancer.

S- Self Breast Examination:

Understanding how to conduct a breast self-examination is crucial. It helps in early detection and can be done monthly.

T – Track Breast Changes:

The alterations the breast experiences make breast cancer symptoms obvious. A woman will notice changes in her breasts’ and nipples’ shapes, discharges, puckered skin, and redness. 

Mammograms are for many women the best technique to detect breast cancer at an early stage, when it is less difficult to cure and before it becomes large enough to feel or produce symptoms.

C: Consult a healthcare worker:

It is always beneficial to consult a healthcare professional. They can perform a clinical breast examination that aids in spotting any alterations to the breast tissues. Any changes you notice should be reported for more analysis.

A: Avoid Hormone Replacement Therapy for a long period:

Steer clear of long-term hormone replacement therapy. Long-term usage of hormone replacement therapy has been linked to an increased risk of breast cancer. 

N: Note your weight:

The risk of developing a number of diseases has been connected to weight gain. Obesity is seen as a risk factor for developing breast cancer. It is really crucial.

C: Consider a yearly mammogram:

Take into account a yearly mammogram: Mammograms are for many women the best technique to detect breast cancer at an early stage, when it is less difficult to cure and before it becomes large enough to feel or produce symptoms. Regular mammograms can reduce the risk of breast cancer-related death. Mammograms are typically advised after age 40.

E- Ensure breastfeeding:

Breast cancer risk has been shown to reduce with continued nursing. While a baby can be breastfed exclusively for the first six months of life, it is encouraged to continue nursing for at least two years.

R – Reduce Stress:

Many epidemiological studies have looked into the connection between stress and cancer and have found that there may be a causal relationship.

“Composed by: Ms. Frincy Francis’s passion is to teach nursing students the art of maternity nursing and shape them into empathetic nurses. Following this passion, she fulfilled her career as a nurse.Currently she is employed as lecturer in the Maternal and Child Health Dept in Muscat, Oman.”

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1. In terms of mortality, as per the Globocan data 2020, in India, BC accounted for 13.5% (178361) of all cancer cases and 10.6% (90408) of all deaths . What is the reason behind such high mortality due to breast cancer?.

There are several reasons that can contribute to the high mortality rate due to breast cancer in India. In my experience major reasons for poor survival rate in India when compared to western countries is the late stage of detection. Many patients are unaware of the signs of the disease, and very few perform self-breast examinations or undergo routine checkups. As a result, most patients are diagnosed at a very late stage. Additionally, the stigma of social embarrassment and isolation is a major deterrent in seeking early care for breast cancer. A few more factors such as dense breasts, lack of adequate diagnostic facilities in tier-2 and tier-3 cities and trained professionals, inadequate or fragmented treatment also contribute to late detection and poor survival. 

2. How does a woman know that she is having breast cancer? What are the basic diagnoses that one can do at home?.

Many women from the community ask me how they will figure out if they have breast cancer. Firstly, remain aware of any hereditary/family history of cancers specifically in immediate family members.  Women can take basic steps at home, to help early detection of breast cancer, such as being vigilant about any changes in their breast and doing regular self-breast examination as shown in Figure 1.  There are specific signs one can look out for shown in the image Figure 2, such as

• Change in size or shape of breast
• Lump or thickening in breast
• Redness or rash around the nipple
• Discharge from the nipple
• Constant pain in breast or armpit
• Inverted or change in position or shape of nipple
• Change in skin texture

3. What is the role of Mammography and how often should it be done?.

A mammogram is an X-ray picture of the breast that’s commonly used by the physician to detect breast lesions. It is typically painless and can help in detection of abnormal lesions in the breast. According to the American Cancer Society (ACS), women above the age of 40 should have mammography done every year.

4. Does any lifestyle change have an impact on reducing Breast cancer risk?.

Although some risk factors associated with breast cancer are beyond our control, healthy modifications to lifestyle can reduce the risk of breast cancer. Healthy lifestyle behaviours for cancer risk reduction include  

• Having a healthy and balanced diet
• Obesity Management
• Active Lifestyle
• Avoid alcohol consumption and smoking
• Young mothers are recommended to breastfeed their infants. As breastfeeding has been shown to have a protective effect towards breast cancer. 

5. Does breast cancer have genetic predisposition? Can you please elaborate on this.

About 5-10% of breast cancers are hereditary, that is they result from certain changes in genes that are directly passed on from a parent. The most talked about breast cancer-related genes are the BRCA1 and BRCA2. Although changes or mutations in these genes can increase the risk of breast cancer to about 60% not all individuals with these mutations will develop breast cancer. According to NCCN guidelines, women diagnosed with breast cancer at a young age or having a strong family history such as breast cancer in immediate family members should undergo genetic testing.

6. Can men also have breast cancer? .

Though breast cancer is most commonly thought of as a disease that affects women, breast cancer does occur in men. As discussed in the previous question, genetic predisposition of mutated genes such as BRCA2 can increase the risk of developing breast and prostate cancers in men.

7. Does breast cancer diagnosed in a lactating mother affect the baby’s health?.

There is no direct effect of breast cancer on the baby’s health. The treatment for breast cancer, such as chemotherapy or radiation, may affect breast feeding ability. Breastfeeding during chemotherapy treatment is not permitted. It is dangerous for infants because they interfere with normal, healthy cell division. Women undergoing radiation therapy can nurse the baby. However, radiation may damage the glands or ducts present in and around the breasts, which can limit the milk production in the affected breast. In such a case, you can breastfeed from the other, unaffected breast. It is best to discuss your options with your physician and identify the best course for you and your child.

8. What is the current gold standard treatment for breast cancer.

Breast cancer treatment varies according to type of tumor, stage of cancer and tumour presentation. Surgery remains the main modality for treatment. In some cases, before the surgery neoadjuvant therapy could be given to shrink the tumor bulk. Surgery is usually followed by adjuvant therapy and radiation to ensure full recovery and minimize the risk of metastases. 

In India, mastectomy or complete removal of the breast is still the main approach to breast cancer management. However, for most females, the appearance of the breast influences their self-perception and self-image. As a result, mastectomy is often known to result in loss of self-esteem and reduced quality of life (QoL) for the woman. Breast-conserving surgery (BCS) is an oncologically safe approach that also maintains the cosmesis of the breast.  BCS has been shown to have better statistically significant outcomes than mastectomy. Patient reported outcomes of BCS show better quality of life, better self-image, and better satisfaction with the surgery compared to mastectomy.

9. You have been involved in many education initiatives around (breast) cancer at National and International level. Could you highlight to us the relevance of these initiatives for the community and what is the gap that you are filling here?.

My practice has always had a multi-pronged approach towards Breast Cancer Management- along with a state of art breast cancer-focused health care unit, we are quite active in capacity building and also run an impactful and exemplary research program. The research program traverses from clinical to molecular to translational research in breast cancer. We also are active in outreach and community awareness through our registered NGO PCCM.

In capacity-building we are at the forefront and run two rich international programs. One is a Masters Program in Oncoplasty in association with University of East Anglia and second is a global educational network for breast cancer physicians and surgeons called BreastGlobal (www.breastglobal.org). Working in resource-constrained settings in an LMIC has mandated the moulding of our approach to breast cancer management specifically for oncoplastic techniques. We have widely published in national and international journals our local surgical adaptations as well as on genetic and molecular aspects of breast cancer in the Indian scenario. 

In 2018, my research unit went on to establish the tissue and data biobank to build a retrospective cohort of breast cancer patients that have been diagnosed and treated at my practice. The biobank is set with the vision that tissue repositories with annotated patient data have been proven to be of immense importance to understand cancer profiles and identify targeted and personalized therapies.

Our capacity building and research efforts will prove to be of national importance as I feel that training and education are cornerstones for development of next generation physicians and will directly impact the well-being of the society. 

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The Trial Assigning Individualized Options for Treatment (Rx) study is the largest ever breast cancer treatment trial that was supported by the United States National Cancer Institute (NCI) and designed and led by the ECOG-ACRIN Cancer Research Group and was published in the New England Journal of Medicine in June. Breast cancer is the most common cancer in women in India and accounts for 27% of all cancers in women. At an incidence rate of 25.8 per 100,000, it is lower than in some developed countries, but the mortality rate (12.7 per 100,000) is comparable to that in western countries. Data on incidence rates of breast cancer from six major cancer registries of India show that the annual percentage increase in the incidence of breast cancer has been in the 0.46 to 2.56% range. The trial enrolled 10,273 women with breast cancer from 6 countries across the globe. It used the Oncotype DX Breast Recurrence Score® (BRS®) test that assesses the expression of 21 genes associated with breast cancer recurrence to assign women with early-stage, HR-positive, HER2-negative, axillary lymph node-negative breast cancer to the most appropriate and effective post-operative treatment.

Also Read: First Digital Breast Tomosynthesis

TAILORx participants with BRS®results from 0 to 10 were treated with endocrine therapy alone based on the prior results from the NSABP B-20 study, which showed no opportunity for chemotherapy benefit. TAILORx participants with BRS results from 26 to 100 were treated with chemotherapy plus endocrine therapy based on the prior results from the NSABP B-20 study, which showed an absolute benefit of chemotherapy greater than 20%. To more precisely define the effect of chemotherapy for women considered to be at intermediate risk for recurrence, 6,711 women with Oncotype DX BRS® results of 11 to 25, the primary study group in TAILORx, were randomized to receive endocrine therapy with or without chemotherapy. These randomized patients comprised two-thirds of all patients enrolled in TAILORx and were followed by the investigators for approximately nine years on average. The majority of breast cancer patients diagnosed worldwide have hormone-positive, HER2-negative, node-negative cancer.

Also Read: Screening for Cervical Precancer in India

The TAILORx study definitively established that chemotherapy may be spared in about 70% of these patients, including all women older than 50 with BRS® results of 0 to 25 and all women age 50 or younger with BRS® results of 0 to 15. Importantly, 30 percent of early-stage breast cancer patients will derive benefit from chemotherapy, including women of any age with BRS® results of 26 to 100, and in women younger than 50, where a modest (2 percent) benefit from chemotherapy was observed with BRS® results of 16 to 20, which gradually grew as scores increased up to and above 25. This important finding reveals a new level of precision of chemotherapy benefit for younger patients that only the Oncotype DX® test can provide. The TAILORx findings can spare thousands of women from getting toxic chemotherapy treatment that really wouldn’t benefit them. The medical fraternity will be highly benefited with this breakthrough finding wherein they will be able to identify the right patients who can benefit from chemotherapy and sparing chemotherapy and its toxic side effects in those who will not benefit from its treatment. The only drawback of the Oncotype DX test is its cost which is around Rs. 2.75 lacs in India. allowed us to avoid chemotherapy for a certain group of patients. We can select the people who don’t need chemo and administer it to only those who need it.”

Source: www.healthtechnology.com

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Artificial Intelligence (AI) is a hot topic, simply put – it’s a way of making a computer think intelligently, in a way human think and over a decade now it has managed to be fairly successful. It has found application in several domains, from consumer electronics like smartphones and smart home devices like Amazon’s Alexa to very niche applications in academic research. What began as a nascent academic pursuit to enable computers to think and solve problems using human-like cognitive capabilities has now invaded most aspects of human life, medicine and healthcare is no exception.

Modern medicine has discovered around 60,000 ways things can go wrong with the human body and over thousands of years have probed these illnesses and disorders to better understand and treat them, one drug, one technique at a time. In recent years, however, there has been a dramatic shift in the pace of innovation in healthcare, especially with the advent of artificial intelligence. Artificial Intelligence is an umbrella term used to cover a wide array of algorithms which mimic human cognitive functions and are self-correcting, and can ‘learn’ from a dataset.

The issues mentioned above are all pertaining to the AI system and its functioning, but there are vital concerns about AI’s effect on people involved in care. Several studies have shown that patients prefer AI chatbots and virtual nurses over humans when learning about their diagnosis as they can proceed to learn at their own pace without the embarrassment of not keeping up with the doctor’s speed. Patients are also more open to conversation with a computer than a human being, part of the reason being the diminished shame and fear associated with being vulnerable. But Allison Pugh, a Professor of Sociology at the University of Virginia and a writer for the New Yorker, thinks that virtual nurses and AI bots offer nothing more than the thinnest veil of care. She writes, “[…] automating or using AI to deliver care would be the same as relying on a “cloth monkey”—a reference to a cruel experiment, carried out in 1959, in which infant monkeys were given a choice between two surrogate mothers, one made from welded wire, the other from terry cloth. (The infants preferred the cloth mother, even when only the wire mother gave them milk.) AI-driven care was a sorry version of the real thing.”

As demonstrated by several research groups, deep learning algorithms have achieved human-level accuracy and then some more. It can look for patterns which are invisible to the human eye. Thus, sooner or later, displacing and relegating doctors from their positions, at least in certain areas of healthcare. This can lead to massive burnouts in doctors as their roles shift drastically and may even lead to a gradual attrition of their skills. But there’s more to care than just interpreting blood reports and imaging data of a patient, it has much more to do about understanding the needs of patients, their mental state, etc. The secret of healthcare is not in reading out objective reports, but in the assurance and the warmth, a doctor’s cadence can provide. “Caring is expressed in listening, in the time-honored ritual of the skilled bedside exam – reading the body – in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.”, writes Abraham Verghese, an author and a physician at Stanford.

Employing AI to most healthcare activities might also have a negative effect on how knowledge is generated. Most medical knowledge generated in the past has been curiosity driven. AI systems can tell us whether the lesion is a benign mole or a tumor, but it can’t provide answers to why the tumor has a corrugated surface or white patches etc.

Artificial intelligence is going to be pervasive across the spectrum of healthcare. From routine lab tests to offering a clinical decision, AI algorithms will play a major role in the future of healthcare. As deep learning algorithms get stronger and as the workings of the black box are revealed, AI technology will make further strides in healthcare. But advancements in AI-based healthcare doesn’t mean the downfall of human doctors. Healthcare is a highly emotional and human-centric field and the “human touch” will always play a pivotal role in the delivery of healthcare. Humans, even highly skilled doctors are fallible beings with inherent limitations and artificial intelligence will not sideline these practitioners but augment their abilities, in making an objectively better yet humane decision.

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