Epidemiological Correlates of Breast Cancer in South India

  • Babu, Giridhara Rathnaiah (Public Health Foundation of India, University of California Los Angeles) ;
  • Lakshmi, Srikanthi Bodapati (Indian Institute of Public Health-Hyderabad, Public Health Foundation of India) ;
  • Thiyagarajan, Jotheeswaran Amuthavalli (Centre for Global Mental Health, Institute of Psychiatry, King's College)
  • Published : 2013.09.30


Background: Breast cancer is the most frequent cancer in women globally and represents the second leading cause of cancer death among women (after lung cancer). India is going through epidemiologic transition. It is reported that the incidence of breast cancer is rising rapidly as a result of changes in reproductive risk factors, dietary habits and increasing life expectancy, acting in concert with genetic factors. Materials and Methods: In order to understand the existing epidemiological correlates of breast cancer in South India, a systematic review of evidence available on epidemiologic correlates of breast cancer addressing incidence, prevalence, and associated factors like age, reproductive factors, cultural and religious factors was performed with specific focus on screening procedures in southern India. Results: An increase in breast cancer incidence due to various modifiable risk factors was noted, especially in women over 40 years of age, with late stage of presentation, lack of awareness about screening, costs, fear and stigma associated with the disease serving as major barriers for early presentation. Conclusions: Educational strategies should be aimed at modifying the life style, early planning of pregnancy, promoting breast feeding and physical activity. It is very important to obtain reliable data for planning policies, decision-making and setting up the priorities.


Breast cancer;epidemiology;South India


  1. Ali R, Mathew A, Rajan B. (2008). Effects of socio-economic and demographic factors in delayed reporting and late-stage presentation among patients with breast cancer in a major cancer hospital in South India. Asian Pac J Cancer Prev, 9, 703-7.
  2. Althuis MD, Dozier JM, Anderson WF, Devesa SS, Brinton LA (2005). Global trends in breast cancer incidence and mortality 1973-1997. Int J Epidemiol, 34, 405-12.
  3. Babu GR (2009). Response to 'Cancer incidence rates among South Asians in four geographic regions: India, Singapore, UK and US'. Int J Epidemiol, 38, 1157-8.
  4. Babu GR, Samari G, Cohen SP, et al (2011). Breast cancer screening among females in iran and recommendations for improved practice: a review. Asian Pac J Cancer Prev: APJCP, 12, 1647.
  5. Chandra A (1979). Problems and prospects of cancer of the breast in India. J Indian Medical Association, 72, 43.
  6. Chauhan A, Subba S, Menezes RG, et al (2011). Younger Women are Affected by Breast Cancer in South India-A Hospitalbased Descriptive Study. Asian Pac J Cancer Prev: APJCP, 12, 709.
  7. Dikshit R, Gupta PC, Ramasundarahettige C, et al (2012). Cancer mortality in India: a nationally representative survey. The Lancet.
  8. Chopra R (2001). The indian scene. J Clinical Oncol, 19, 106-11.
  9. Dey S, Boffetta P, Mathews A, et al (2009). Risk factors according to estrogen receptor status of breast cancer patients in Trivandrum, South India. Int J cancer, 125, 1663-70.
  10. Dhillon P, Yeole B, Dikshit R, Kurkure A, Bray F (2011). Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976‚Ai2005: an age‚Aiperiod‚Aicohort analysis. British J cancer, 105, 723-30.
  11. Dumitrescu R, Cotarla I (2005). Understanding breast cancer risk-where do we stand in 2005? J cellular and molecular medicine, 9, 208-21.
  12. Gajalakshmi C, Shanta V (1991). Risk Factors for Female Breast Cancer A Hospital-Based Case-Control Study in Madras, india. Acta Oncol, 30, 569-74.
  13. Gauthier D (2003). Reviews: Breast Cancer, Pregnancy, and Breastfeeding Principal Authors: M. Helewa, P. Lévesque, and D. provencher breast disease committee, executive council of the society of obstetricians and gynaecologists of Canada SOGC clinical practice guidelines. J Human Lactation, 19, 93-4.
  14. Goel A, Seenu V, Shukla N, Raina V (1995). Breast cancer presentation at a regional cancer centre. The National Med J India, 8, 6.
  15. Hall JM, Lee MK, Newman B, et al (1990). Linkage of earlyonset familial breast cancer to chromosome 17q21. Science, 250, 1684-9.
  16. Harrison PA, Srinivasan K, Binu V, Vidyasagar M, Nair S. (2010). Risk factors for breast cancer among women attending a tertiary care hospital in southern India. Int J Collab Res Internal Med Public Health, 4, 109-116.
  17. Kuraparthy S, Reddy KM, Yadagiri LA, et al (2007). Epidemiology and patterns of care for invasive breast carcinoma at a community hospital in Southern India. World J Surg Oncol, 5, 56.
  18. Jayalekshmi P, Varughese SC, Nair M, et al (2009). A nested case-control study of female breast cancer in Karunagappally cohort in Kerala, India. Asian Pac J Cancer Prev, 10, 241-6.
  19. Jin F, Devesa SS, Chow WH, et al (1999). Cancer incidence trends in urban shanghai, 1972-1994: an update. Int J Cancer, 83, 435-40.<435::AID-IJC1>3.0.CO;2-J
  20. Kelsey JL, Gammon MD, John EM (1993). Reproductive factors and breast cancer. Epidemiologic reviews, 15, 36.
  21. Leung GM, Thach TQ, Lam TH, et al (2002). Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis. Br J Cancer, 87, 982-8.
  22. Li CI, Anderson BO, Daling JR, Moe RE (2003). Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA, 289, 1421-4.
  23. Li CI, Daling JR (2007). Changes in breast cancer incidence rates in the United States by histologic subtype and race/ ethnicity, 1995 to 2004. Cancer Epidemiol Biomarkers Prev, 16, 2773-80.
  24. Lodha R, Joshi A, Paul D, et al (2011). Association between reproductive factors and breast cancer in an urban set up at central India: A case-control study. Indian J cancer, 48, 303.
  25. Marmot M, Atinmo T, Byers T, et al (2007). Food nutrition physical activity and the prevention of cancer: a global perspective. Washington DC AICR, 46.
  26. Mathew A, Gajalakshmi V, Rajan B, et al (2008). Anthropometric factors and breast cancer risk among urban and rural women in South India: a multicentric case-control study. British J cancer, 99, 207-213.
  27. Moher D, Liberati A, Tetzlaff J, Altman DG (2009b). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med, 6, 1000097.
  28. McPherson K, Steel C, Dixon J (2006). Breast cancer- epidemiology, risk factors and genetics. ABC of Breast Disease, 3rd edn.(ed. JM Dixon), 24-9.
  29. McPherson K, Steel CM, Dixon J (2000). Breast cancerepidemiology, risk factors, and genetics. Brit Med J, 321, 624-8.
  30. Moher D, Liberati A, Tetzlaff J, Altman DG (2009a). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine, 6, 1000097.
  31. Nanda AK, Malhi P, Kaur K, et al (1995). National Family Health Survey (NFHS-1) 1993: Punjab. Chandigarh: Population Research Centre, Center for Research in Rural and Industrial Development, and Bombay: International Institute for Population Sciences.
  32. Nandakumar A, Anantha A, Venugopal T (1998). Populationbased survival from breast and cervical cancer and lymphoreticular malignancies in Bangalore, India. IARC Sci Publ, 61-8.
  33. Nandakumar A, Anantha N, Venugopal T,et al(1995). Survival in breast cancer: A population based study in Bangalore, India. Int J Cancer, 60, 593-6.
  34. Pakseresht S, Ingle G, Bahadur A, et al (2009). Risk factors with breast cancer among women in Delhi. Indian J Cancer, 46, 132.
  35. Peto R, Boreham J, Clarke M, Davies C, Beral V (2000). UK and USA breast cancer deaths down 25% in year 2000 at ages 20?69 years. The Lancet, 355, 1822.
  36. Sciences, IIFP (2007). National Family Health Survey (NFHS- 3), 2005-06: India: International Institute for Population Sciences.
  37. Surekha D, Sailaja K, Rao D, et al (2010). Association of a CYP17 gene polymorphism with development of breast cancer in India. Asian Pac J Cancer Prev, 11, 1653.
  38. Sciences, IIFP ORC, Macro (2000). National Family Health Survey (NFHS-2) 1998-99: India. IIPS Mumbai.
  39. Seow A, Duffy SW, McGee MA, Lee J, Lee HP (1996). Breast cancer in Singapore: trends in incidence 1968-1992. Int J Epidemiol, 25, 40-5.
  40. Shapiro S, Coleman EA, Broeders M, et al (1998). Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening. Int J Epidemiol, 27, 735-42.
  41. Syamala V, Syamala V, Sreeja L, et al (2008a). Hereditary breast/ovarian cancer: clinicopathological characteristics and survival of BRCA2 positive and negative cases. J Exp Therapeut Oncol, 7, 227.
  42. Syamala VS, Sreeja L, Syamala V, et al (2008b). Influence of germline polymorphisms of GSTT1, GSTM1, and GSTP1 in familial versus sporadic breast cancer susceptibility and survival. Familial Cancer, 7, 213-20.
  43. Syamala VS, Syamala V, Sreedharan H, et al (2009). Contribution of XPD (Lys751Gln) and XRCC1 (Arg399Gln) polymorphisms in familial and sporadic breast cancer predisposition and survival: an Indian report. Pathol Oncol Res, 15, 389-97.
  44. Takiar R, Vijay C (2010). An alternative approach to study the changes in the cancer pattern of women in India (1988‚Ai2005). Asian Pac J Cancer Prev, 11, 1253-6.
  45. Vaidyanathan K, Lakhotia S, Ravishankar H, et al (2009). BRCA1 and BRCA2 germline mutation analysis among Indian women from south India: identification of four novel mutations and high-frequency occurrence of 185delAG mutation. J Biosciences, 34, 415-22.
  46. Yeole BB, Kurkure A (2003). An epidemiological assessment of increasing incidence and trends in breast cancer in Mumbai and other sites in India, during the last two decades. Asian Pac J Cancer Prev, 4, 51-6.
  47. Yip PS, Lee J, Chan B, Au J (2001). A study of demographic changes under sustained below-replacement fertility in Hong Kong SAR. Soc Sci Med, 53, 1003-9.

Cited by

  1. Awareness of Risk Factors for Cancer among Omani adults- A Community Based Study vol.15, pp.13, 2014,
  2. Relation of Alcohol/Tobacco use with Metastasis, Hormonal (Estrogen and Progesterone) Receptor Status and c-erbB2 Protein in Mammary Ductal Carcinoma vol.15, pp.14, 2014,
  3. Descriptive Study on Selected Risk Factors and Histopathology of Breast Carcinoma in a Tertiary Care Centre in Kerala, India with Special Reference to Women Under 40 Years Old vol.16, pp.1, 2015,
  4. Immunohistochemical Profile of Breast Cancer Patients at a Tertiary Care Hospital in New Delhi, India vol.16, pp.12, 2015,
  5. Alteration of Thyroid Function in Indian HER 2-Negative Breast Cancer Patients Undergoing Chemotherapy vol.16, pp.17, 2015,
  6. Epidemiology of breast cancer in Indian women vol.13, pp.4, 2017,
  7. A qualitative exploration of cervical and breast cancer stigma in Karnataka, India vol.17, pp.1, 2017,
  8. Physical activity participation and the risk of chronic diseases among South Asian adults: protocol for a systematic review and meta-analysis vol.7, pp.1, 2018,
  9. Rate of Breast-Conserving Surgery vs Mastectomy in Breast Cancer: a Tertiary Care Centre Experience from South India pp.0976-6952, 2018,