Breast cancer is increasingly affecting younger women in India, with cases being reported even among those in their 30s. Recognising warning signs, understanding risk factors and seeking timely medical advice can make a difference. In this interview, Dr Geeta Chadha, Senior Consultant in the Department of Gynaecology, Indraprastha Apollo, New Delhi explains the symptoms women should watch for, the role of family history and hormones, and the importance of breast awareness and screening.
Q: Breast cancer is becoming an increasingly significant health burden in India, with younger women also being diagnosed. What are you seeing in your practice?
Dr Geeta Chadha: We are seeing more and more cases of breast cancer in India, even in women in their 30s. In 1970s and 1980s, we were taught that cervical cancer was the leading cancer among women in India, while breast cancer was more common in the West. That picture is changing, and we are increasingly seeing younger women presenting with breast cancer.
One reason we may be seeing more younger patients is our population’s age structure. India has a large young population, so we will also see more health problems among younger people. Environmental, hormonal, and lifestyle factors may also play a role.
Published literature suggests that Indian women tend to present with breast cancer at a younger age than women in Western countries. Genetic predisposition and lifestyle differences may contribute, but I wouldn't give a precise figure without referring to the data.
Q: What are the warning signs of breast cancer that women in their 30s and 40s should never ignore?
Dr Chadha: Any new lump that a woman feels in her breast is a warning sign that needs medical evaluation. She may notice that an area feels different or that the skin has changed in appearance or texture. There may also be a lump in the breast or armpit.
One important sign is an orange-peel appearance of the skin. The skin may become puckered or dimpled, resembling an orange peel.
Another warning sign is nipple discharge, particularly bloody discharge that occurs spontaneously, without squeezing or pressing the nipple.
A woman may also notice that her breasts have become asymmetrical, either in size or in skin appearance. Redness, warmth, swelling or pain may sometimes indicate an infection, but a small proportion of breast cancers can present with inflammatory changes.
Women should become familiar with the normal appearance and feel of their breasts. Any new or unexplained change should prompt a visit to the doctor.
Q: Many women believe that if a breast lump is painless, it is probably harmless. Is that true?
Dr Chadha: No. Many breast cancers are painless, so women should not wait for a lump to hurt before seeking medical advice. At the same time, a painful lump can also be cancerous.
Whether a lump hurts or not, a new lump or other unexplained change needs medical attention.
Q: India has a significant gap in breast cancer screening. What should women do to become more aware of their breast health?
Dr Chadha: Screening is for people without symptoms. When someone has a symptom, such as a new lump, that is no longer a screening situation; it requires diagnostic evaluation.
I encourage women in their 20s to become familiar with their breasts. They should look at them in the mirror and understand what is normal for them.
In their 30s, women can learn how to examine their breasts systematically. Using the pads of their fingers, they can gently feel each area, moving methodically to cover the entire breast. They should also examine the armpit for any unusual lump.
For women who menstruate, it is preferable to examine the breasts after their period, when hormonal influences are relatively lower. Before menstruation, hormonal changes can make the breasts feel lumpy or tender. This normal lumpiness may cause unnecessary anxiety.
The purpose of breast awareness is to help women recognise new changes, not to create fear or lead to unnecessary investigations. If a woman notices a new lump, nipple discharge, or a change in the skin, she should seek medical advice.
For women who have reached menopause, choosing a consistent date each month can help them maintain breast awareness.
Q: At what age should women begin mammography, and who may need screening earlier?
Dr Chadha: Screening recommendations vary across countries and depend on a woman’s age and risk factors. In general, mammography is increasingly recommended from around age 40, although frequency and starting age depend on individual circumstances and the guidelines followed.
If a woman has a strong family history of breast cancer or a suspected hereditary predisposition, screening may need to begin earlier.
Breast density is another consideration. Dense breast tissue can appear white on a mammogram, and cancers may also appear white, making them harder to identify. In such cases, ultrasound may provide additional information.
Depending on a woman’s age, breast density and risk profile, doctors may recommend mammography, ultrasound or other imaging investigations. Younger women who are at high risk may also need an MRI.
Doctors should individualize the choice of investigation rather than use a single rule for everyone.
Q: Many women assume they are safe if no one in their family has had breast cancer. How important is family history?
Dr Chadha: A large proportion of women diagnosed with breast cancer have no previous family history of the disease. A lack of family history should never lead a woman or her doctor to dismiss a suspicious lump.
However, a strong family history increases risk and should be taken seriously.
First-degree relatives, such as a mother, sister, or daughter, are particularly important when assessing family history. Certain inherited genetic variants, including BRCA1 and BRCA2, can substantially increase the risk of breast and ovarian cancers.
A family history of cancers occurring at younger ages, several relatives with cancer, or male breast cancer may also raise suspicion of an inherited cancer predisposition.
Women with a strong family history should discuss their risk with a specialist. They may need genetic counselling, appropriate testing and a more intensive surveillance plan.
Q: How do reproductive and hormonal factors, such as early menstruation, late pregnancy and menopause, influence breast cancer risk?
Dr Chadha: Breast tissue responds to oestrogen and other hormones. The longer a woman is exposed to certain hormonal influences over her lifetime, the greater her risk of developing breast cancer may be.
Early menstruation and menopause at a later age can mean a longer period of hormonal exposure. Having a first full-term pregnancy at a later age is also associated with breast cancer risk.
Hormone replacement therapy can affect risk, depending on the type of treatment and how long it is used. The relationship between hormonal contraception and breast cancer is more complex, and women should discuss their individual circumstances with their doctors rather than make decisions based on fear.
These factors influence risk, but none of them determines with certainty whether an individual woman will develop breast cancer.
Q: Does breastfeeding offer protection against breast cancer?
Dr Chadha: Breastfeeding is associated with a reduction in breast cancer risk. Research suggests the risk decreases with longer breastfeeding.
It is one factor that can reduce a woman’s risk, although it cannot eliminate it.
Q: Beyond genetics and reproductive factors, how important are lifestyle and environmental influences?
Dr Chadha: Research suggests that a proportion of cancers are associated with modifiable risk factors. We cannot change our inherited genes through ordinary lifestyle measures, but we can address certain factors that influence our health.
Physical activity, maintaining a healthy weight, particularly after menopause, and eating a balanced diet are important. Women should include vegetables, fruits, legumes and other plant-based foods in their diets and limit highly processed foods.
Obesity after menopause is an important consideration because fat tissue contributes to oestrogen production.
Regular exercise, maintaining a healthy weight, eating well and avoiding smoking and alcohol can contribute to lowering cancer risk and improving overall health.
These measures cannot guarantee that a woman will never develop breast cancer, but they are meaningful steps towards reducing preventable risks.
Q: Why are some women still diagnosed with breast cancer at an advanced stage, despite the growing awareness around the disease?
Dr Chadha:
The medical fraternity plays an important role. Women may initially visit a physician, dermatologist or another doctor for an unrelated complaint. These doctors may not always examine the breasts or consider whether a change warrants further evaluation.
We need to sensitise doctors across specialties to recognise warning signs and refer patients when necessary. Nurses can also help educate women and encourage them to seek care when they notice changes.
Gynaecologists routinely examine women and may identify suspicious breast changes during consultations. But awareness cannot be limited to gynaecologists.
Women also need clear information about the symptoms to watch for and where to seek help. Even if a primary health centre lacks mammography facilities, it should be able to refer a woman to an appropriate center.
Q: What is your final message to women on breast cancer awareness and prevention?
Dr Chadha: My first message is that women need to become familiar with their breasts and learn to recognise changes. Breast awareness should begin early, and women should know when to seek medical advice.
Screening should be based on age and individual risk. Women eligible for mammography should follow the recommended schedule, while those with a strong family history or hereditary predisposition may need earlier screening.
A healthy lifestyle, including appropriate nutrition and regular physical activity, is also important.
Women should understand their family history. It is not enough to know that a relative died of cancer; it is important to find out what type of cancer they had and, if possible, at what age they were diagnosed.
Women with a high hereditary risk, including certain BRCA1 or BRCA2 variants, should discuss their options with specialists. Depending on their individual risk, these may include enhanced surveillance and, in selected cases, risk-reducing surgery.
The message is simple: spread awareness, help women feel confident in their bodies, and ensure they have access to appropriate healthcare.