Breast Cancer in India: 6 in 10 Patients Diagnosed at an Advanced Stage, Says Dr Atul Batra

Breast cancer is now the most commonly diagnosed cancer in India, with many patients reaching hospitals only when the disease is already advanced. Around 60% of patients present with locally advanced breast cancer, while only 30% are diagnosed at an early stage, says Dr Atul Batra, Professor, Department of Oncology at AIIMS Delhi. The lack of a nationwide, organized mammography screening program, along with gaps in awareness and delays in seeking treatment, remains a major challenge. Although advances in targeted therapies and immunotherapy have improved treatment options, their high cost keeps them out of reach for many patients. Early detection and equitable access to treatment remain critical to improving outcomes.

Excerpts from an interview

Q: What is the scale of the breast cancer problem in India?

Dr Atul Batra: Breast cancer is now the most commonly diagnosed cancer in India. Its incidence has been rising over the past several years, making it a major public health concern. It is also among the most commonly diagnosed cancers globally.

Q: Are we seeing breast cancer increasingly affecting younger women? Is the age profile of patients changing?

Dr Batra: India is a relatively young country, so we will naturally have more younger patients than countries such as the US, which have older populations. The median age at diagnosis in India is around 50–51 years, roughly a decade younger than in Western countries.

We do see patients in their 40s, and these cases often receive considerable attention because of their younger age. However, the median age has remained relatively stable over the years. Since the absolute number of breast cancer cases is increasing across age groups, we are also seeing more younger patients in absolute numbers.

Q: Late diagnosis is often cited as a major problem in India. What proportion of patients are diagnosed at an advanced stage?

Dr Batra: We broadly classify breast cancer into early-stage disease, locally advanced disease and metastatic disease. Early-stage cancer generally refers to stages I and II, locally advanced cancer to stage III, and metastatic cancer to stage IV.

In India, approximately 30% of patients present with early-stage disease, around 60% with locally advanced disease and about 10% with metastatic disease at the time of diagnosis. In other words, six out of 10 patients present with locally advanced breast cancer, which may involve a large tumour or lymph nodes.

In many developed countries, around 60–70% of patients are diagnosed at an early stage. This difference highlights the extent of delayed diagnosis in India. Moreover, some patients diagnosed at an earlier stage may later develop metastatic disease.

Q: What are the main gaps in breast cancer screening and early detection in India?

Dr Batra: We do not yet have a nationwide, organised mammography-based breast cancer screening programme. Screening in India is largely opportunistic. A woman visiting a hospital for another reason may be advised to undergo screening, particularly if she is in the relevant age group. However, this depends on whether the facility has the necessary equipment and services.

Women do not routinely receive invitations for mammography through a national screening system, and primary healthcare settings offer limited access.

In many countries, screening is generally recommended from around age 40–45 to 70–75, with mammography performed annually or every two years, depending on the guidelines. Women with a strong family history or certain inherited genetic mutations may need to begin screening much earlier, sometimes around age 25, with a more intensive surveillance plan.

Q: How important is breast self-examination in India?

Dr Batra: In India, breast self-examination can be important because many women present only after noticing a large lump. Educational videos and apps can help women understand what to look for and become familiar with changes in their breasts.

Studies in Western countries have not demonstrated that routine breast self-examination reduces breast cancer mortality but they focus on tools like mamography. However, the Indian context is different because so many women are diagnosed late. Indian studies suggest that clinical breast examination, performed by a trained healthcare professional, may help detect disease earlier and potentially reduce mortality.

However, recognising a lump is only the first step. Women must also reach an appropriate healthcare facility.

Q: Apart from early detection, what are the other major gaps in breast cancer care?

Dr Batra: I would identify three major gaps.

The first is getting women to seek medical attention earlier. The second is ensuring that they reach the right hospital and receive appropriate treatment. The third is helping them complete their treatment.

Breast cancer treatment can extend over several months. Chemotherapy may last six months or longer, depending on the regimen, while hormone therapy may continue for five or even 10 years. Some patients undergo surgery but do not complete recommended chemotherapy or radiotherapy. Others discontinue treatment because of financial constraints or difficulties accessing healthcare.

Of these gaps, delayed presentation remains the most important, followed by access to appropriate treatment.

Q: What are the major risk factors for breast cancer? Are obesity, physical inactivity and alcohol consumption contributing to the rising burden?

Dr Batra: Risk factors can broadly be divided into non-modifiable and modifiable factors.

Non-modifiable factors include age, genetic predisposition and family history. The risk generally increases with age, and women with certain inherited genetic mutations or a strong family history may be at higher risk.

Many modifiable risk factors relate to cumulative exposure to female hormones, particularly oestrogen. Early onset of menstruation, late menopause, having children later in life, not having children and not breastfeeding can influence this exposure. As women marry and have children later, or choose not to have children, these reproductive patterns may influence breast cancer risk.

Other associated factors include obesity, physical inactivity, alcohol consumption and smoking. However, no single risk factor explains most breast cancer cases. Some women develop the disease despite having none of the recognised risk factors.

Q: What role does genetic testing play in breast cancer management today?

Dr Batra: Genetic testing has become much more accessible. Previously, comprehensive testing could cost more than ₹1 lakh; costs have fallen substantially, and some tests may now cost around ₹10,000–12,000, depending on the test and laboratory.

Testing is particularly relevant for patients diagnosed at a young age, those with triple-negative breast cancer, patients with a strong family history, and those meeting other clinical criteria.

However, this does not mean every woman without breast cancer should undergo genetic testing. If a family member carries a pathogenic mutation, other relatives should consult a genetic counselor to determine whether testing is appropriate. Pre-test and post-test counseling are important.

Q: Breast cancer treatment has advanced considerably, with immunotherapy and targeted drugs becoming available. How affordable are these treatments in India?

Dr Batra: Breast cancer is not one uniform disease. Treatment depends on the tumour’s biological subtype—whether it is hormone-receptor positive, HER2-positive or triple-negative—as well as its stage and prior treatment.

Triple-negative breast cancer can be particularly challenging because treatment options are more limited and some patients require expensive immunotherapy. A drug regimen can cost around ₹10 lakh annually, even with patient-assistance programmes. Research suggests lower doses of certain immunotherapy drugs may remain effective in specific settings, potentially reducing costs. Still, the findings must be interpreted in the context of the evidence and treatment regimen.

HER2-positive breast cancer has several targeted options, including antibody-based therapies and newer antibody-drug conjugates. Costs vary widely, from a few lakh rupees to tens of lakhs, depending on the drug, disease stage and treatment duration.

Hormone-receptor-positive disease that has not spread to other organs can often be treated with comparatively affordable oral medicines. Advanced disease may require molecular testing and expensive targeted drugs, some of which need to be imported.

There is no single figure for breast cancer treatment. Some patients do well on relatively affordable medicines, while others may need drugs costing several lakh rupees a month.

Q: What are the survival prospects for women diagnosed with breast cancer in India?

Dr Batra: Survival varies considerably by stage at diagnosis, tumor subtype, and treatment received. It would be misleading to give one survival figure for every breast cancer patient.

When breast cancer is detected at stage I and treated appropriately, the chances of cure are very high. In some cases, the likelihood of cure can be around 95%. Many patients with intermediate-stage disease can also be treated successfully.

The situation is different when the cancer has spread to organs such as the liver or lungs. Stage IV breast cancer is generally not considered curable, but it is treatable. Some patients, particularly those with hormone-receptor-positive disease, can live for many years with appropriate treatment.

Q: What three changes would you recommend for India's breast cancer programme over the next five years?

Dr Batra: First, we need to strengthen early detection. Given the high proportion of locally advanced cases, we could begin by expanding clinical breast examination and strengthening referral systems. As more women are diagnosed at earlier stages and healthcare capacity improves, India could work towards a more extensive mammography-based screening programme.

Second, we need sustained public awareness campaigns. Every woman should know that a breast lump or an unusual breast change needs medical evaluation, and that breast cancer can be treated and, particularly when detected early, often cured.

Third, we need universal access to essential breast cancer treatment. We should progressively expand public coverage to include appropriate diagnostic services, surgery, chemotherapy, radiotherapy and other evidence-based treatments.

The objective should be to make breast cancer care accessible, affordable and available to every woman who needs it.