Dr RG Wiseman Pinto
Breast cancer is the commonest cancer among women in Goa, accounting for 22 to 30% of all cancers in women, according to studies conducted over 20 years by the author and his postgraduate students, Dr Manali Bandekar and Dr Anjali Naik, at Goa Medical College (GMC).
The author, along with successive Chief Ministers, Health Ministers, GMC, the Directorate of Health Services, the Goa Cancer Society, doctors, professional bodies, NGOs, municipalities, panchayats, educational institutions and other organisations, has contributed significantly to cancer prevention, diagnosis, treatment and palliative care. However, Goa continues to face a substantial burden of breast cancer as its population grows and lifestyles change.
Today, the need of the hour is health education of breast self-examination to be done by all women once they attain the age of 20, and it should be ideally done regularly after a woman's menstrual period - every month, every year, even when they are in their 80s and 90s.
Every woman above 20 must be educated about breast self-examination. Women should examine both breasts and armpits and look for changes in the skin, nipples and areola. Any lump, thickening or unusual change requires immediate medical consultation. Breast self-examination can be learnt from doctors, nurses, paramedics and reliable educational resources.
Examination is ideally performed after menstruation, when the breasts are softer. Women with a family history of breast cancer, particularly when a relative was diagnosed at a young age, need earlier medical assessment and appropriate screening. The author has encountered an 18-year-old patient whose mother had died of breast cancer.
A breast lump must never be ignored, even though most lumps are benign. Clinical examination, imaging and tissue diagnosis through fine-needle aspiration cytology (FNAC) or core needle biopsy help establish the diagnosis. Ultrasound, mammography and, in selected cases, MRI may be required. The triple assessment combines clinical findings, imaging and pathological examination. Artificial intelligence is also being incorporated into diagnostic imaging.
Digital mammography can detect small lesions that conventional imaging may miss. Such lesions require assessment by specialised breast imaging experts. Larger palpable masses can often be evaluated through FNAC or core biopsy.
Family history on both the maternal and paternal sides is important. Approximately 10% of breast cancers have a family history, while around 3% are genetic, according to the information presented by the author. Mutations involving BRCA1, BRCA2 and other genes can be investigated using molecular techniques, including PCR, FISH and next-generation sequencing. Genetic counselling should precede testing.
Goa needs more qualified surgical, medical and radiation oncologists, oncopathologists, counsellors, advanced radiation equipment, linear accelerators and PET-CT facilities. More palliative care centres are also essential. Although the government has a tie-up with Tata Memorial Hospital, specialist services must be available in Goa around the clock.
Cancer treatment requires a multidisciplinary approach involving tumour boards, accurate diagnosis, surgery, chemotherapy, radiotherapy, immunotherapy and personalised medicine. Biomarkers such as oestrogen receptors, progesterone receptors and HER2 help guide treatment. Prevention remains crucial because cancer care is expensive.
The community-based Cancer Registry established by the Government of Goa with Tata Memorial Hospital in 2008 collected data from hospitals across the State. Its findings were published by ICMR and Tata Memorial Hospital. However, funding for staff salaries was stopped. Reviving and strengthening cancer registration is vital for planning effective public health programmes.
The author has also observed cancers diagnosed during pregnancy and lactation, multiple cancers in individual patients and occasional breast cancer in men. Breast cancer can occur across socioeconomic groups and may affect younger women. Any suspected mass requires proper medical evaluation rather than unproven alternative treatments, which can waste valuable time.
Lifestyle and environmental factors also deserve attention. The author has raised concerns about possible associations involving dietary exposures, pollution, microplastics and radiation. These concerns must be addressed through appropriate research and evidence-based public health measures.
Women sometimes delay seeking medical attention because of embarrassment or fear, presenting only when the disease has advanced. Breastfeeding and reproductive factors may influence risk, but they do not eliminate the possibility of cancer. Long-term follow-up is essential.
Goa needs sustained public education involving healthcare professionals, schools, community organisations and print, electronic and social media. Dedicated NGOs must support awareness, screening, treatment and patient care.
Breast cancer awareness must translate into action. Educating every girl and woman about breast health, recognising warning signs and seeking prompt medical assessment can help improve outcomes.
(The writer is a Professor of Pathology, former Head of Department at Goa Medical College, former Dean of Goa University and the current President of the Asian Society of Cytopathology)
