South Asian breast cancer patients living in Yorkshire may have higher rates of mastectomy compared with non-Asians because they present to their GPs too late, Cancer Research UK scientists reveal.
Researchers examined data from 1986 to 1994 on nearly 17,000 women in Yorkshire, of which 120 patients were South Asian. Preliminary findings show that the incidence of breast cancer rose faster in South Asians than in any other group.
The study, conducted at the Cancer Research UK Clinical Centre in Leeds, shows that the number of breast cancer patients is rising from Bangladeshi, Indian and Pakistani communities as these populations age and increase in numbers. Changes in lifestyle and diet contribute to this trend, but further research is necessary to explain the observed increase.
Researchers revealed that South Asian women delayed their first GP visit about initial breast abnormalities for about two months, twice as long as non-Asians.
The time taken to report any breast changes can affect treatment options.
By the time of diagnosis, the tumours in South Asians were often more advanced than non-Asians and required radical surgery. Breast-preserving options, such as tumour excision followed by radio- or chemotherapy, were probably not viable alternatives in many cases.
The authors suggest that the high mastectomy rate may be a result of poor breast cancer awareness in South Asian women living in Yorkshire, compounded by low participation in breast screening.
Encouragingly, once breast cancer was diagnosed, South Asians were treated promptly and their survival was similar to non-South Asian women.
Dr G. Velikova, at Cancer Research UK, says: “South Asians had a significantly longer patient-related delay before visiting their doctor, and subsequently presented with larger tumours that often resulted in mastectomy.
“It is vital that South Asian women are encouraged to take part in breast screening and that awareness of the disease is made a priority at general practices. There is an urgent need to explore the reasons for this delay, and to develop breast cancer awareness programmes specifically targeting South Asian women to encourage participation in these communities.”
This research will help healthcare professionals target minority ethnic groups to encourage women to have breast screening and to recognise symptoms earlier.
Cancer Research UK’s Cancer Information Director Dr Lesley Walker says: “Although survival rates of breast cancer in South Asians are similar to non-Asians, which is reassuring, the mastectomy rate during this time period is cause for concern. Using these findings as a basis for future research, we need to determine whether this situation has changed in the last ten years, and find out why South Asians delay visiting their doctors about breast abnormalities. Programmes to increase breast cancer awareness must be encouraged.”
- British Journal of Cancer90 (10)
- This retrospective study of data examined the effect of ethnicity on delivered treatment, and patient and provider delays to diagnosis and (hospital) treatment.
- Although a significantly larger proportion of South Asians belonged to deprived socio-economic groups, after controlling for socio-economic deprivation, poverty was not found to be a factor.
- South Asians received similar treatment to and access to treatment as non-Asian patients, but the mastectomy rate was higher. Ethnicity was not associated with different surgical treatment or a different treatment approach to South Asians.
- The NHS Breast Screening Programme was introduced in 1988 and information was collected on the number of screened patients up to 1994. Very few women had been screened in either group. More research is needed to provide an overview of the current situation.
- One woman in nine in the United Kingdom will develop breast cancer during her lifetime.
- Each year 41,000 women are newly diagnosed with breast.
- On average almost 13,000 women die from breast cancer every year.
- Breast cancer is the most commonly diagnosed female cancer in the UK.
- Breast screening by mammography has been shown in all randomised trials of women aged 50 and over to reduce mortality from breast cancer.
- Breast awareness five point code:
- Know what is normal for you
- Look and feel
- Know what changes to look for
- Report any changes without delay
- Attend for breast screening if aged 50 or over
- Changes to look for:
- Appearance. Any changes in the outline or shape of breast, especially those caused by arm movements, or by lifting the breasts. Any puckering or dimpling of skin
- Feelings. Discomfort or pain in one breast that is different from normal, particularly if new and persistent
- Lumps. Any lumps, thickening or bumpy areas in one breast or armpit, which seems to be different from the same part of the other breast or armpit. This is very important if new
- Nipple change. Nipple discharge, new for you and not milky. Bleeding or moist reddish areas, which do not heal easily. A nipple rash on or around nipple