Breast Cancer In Kashmir: Understanding A Growing Health Challenge

The increase in breast cancer is likely due to a combination of biological, lifestyle, reproductive, social and health-system factors. Changing reproductive patterns—late marriage, delayed first pregnancy, fewer children, reduced breastfeeding and early menarche—can increase lifetime exposure to estrogen, while rising obesity, sedentary lifestyles, tobacco and alcohol exposure, and genetic susceptibility also play a role. Low awareness, stigma, and Kashmir’s rural and mountainous terrain, with specialist cancer services concentrated in Srinagar, further contribute to delayed consultation and diagnosis.

Kashmir needs a coordinated response: community awareness in Kashmiri, Urdu and Gojri; school and workplace education; training of ASHA workers and primary-care staff; mobile mammography with reliable referral; a population-based cancer registry; and psycho-social support for patients and families. All diagnostic and treatment facilities are available in Kashmir, leaving no need for patients to move outside the valley. Breast cancer is serious, but it is not silent or untreatable—every woman should know her breasts, report changes without delay, and encourage the women around her to do the same.

Breast cancer is the abnormal, uncontrolled growth of cells in the breast, usually beginning in the milk ducts or lobules. It is the most common cancer among women worldwide and, in India, has overtaken cervical cancer as the leading cancer affecting women. While the disease can be life-threatening, it is also highly treatable when detected early; the central challenge in Kashmir is not merely rising case numbers, but late presentation, low screening uptake, and delayed access to specialist care.

Global burden

Globally, an estimated 2.4 million women were diagnosed with breast cancer in 2024, and about 694,000 diagnosed died from the disease. Breast cancer accounted for 11.8% of all new cancer cases and 7.1% of all cancer deaths worldwide, making it the second most commonly diagnosed cancer overall and the most common cancer among women.

Breast cancer is now the most frequently diagnosed cancer among women in 164 of 186 countries and the leading cause of cancer death among women in 122 countries. The burden is unequal: in very high-human-development countries, about 1 in 12 women may be diagnosed in her lifetime, while in low-human-development countries about 1 in 27 women may be diagnosed- but 1 in 48 may die from it, reflecting major gaps in early detection and treatment.

Breast Cancer in India

India faces a particularly concerning pattern. Breast cancer is the leading cancer among Indian women, accounting for roughly 13.5% of all new cancer cases and about 10% of cancer-related deaths. National estimates place the age-standardised incidence at about 32 per 100,000 women and mortality at about 15.1 per 100,000 women.

Recent estimates suggest about 238,000 new breast cancer cases and more than 102,000 deaths among Indian women in 2024. Unlike many high-income countries, where incidence is high but mortality has fallen due to organized screening and early treatment, India continues to see a high proportion of women diagnosed at advanced stages.

The Situation in Kashmir

Kashmir has seen a clear rise in breast cancer cases over the past two decades. Hospital-based data from the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) reported 1,611 breast cancer cases between 2000 and 2012, representing 16.38% of 9,575 registered cancers. Earlier studies have also described breast cancer as the second most common malignancy among Kashmiri women, with an estimated incidence of about 12.6 per 100,000 women.

The available Kashmir data are mostly hospital-based rather than population-based, so exact current incidence and mortality figures for the valley remain uncertain. Nevertheless, published reviews consistently report that breast cancer is among the leading cancers in Kashmir, that cases are increasingly seen in younger and premenopausal women, and that a large share presents at advanced stages.

A major concern is delayed diagnosis. Studies from tertiary centres in Kashmir report that roughly 70-73% of patients present with stage III disease, while only about 27% present at stage II. This late-stage pattern sharply reduces treatment options and survival compared with cancers detected when they are small and localized.

Why cases are increasing in Kashmir

The increase in breast cancer in Kashmir is likely due to a combination of biological, lifestyle, reproductive, social, and health-system factors. No single cause explains the trend, but several risks are increasingly relevant.

1. Changing reproductive patterns: Late marriage, delayed first pregnancy, fewer children, reduced breastfeeding, and early menarche can increase lifetime exposure to estrogen. Kashmiri studies have identified early menarche and late first childbirth as important risk factors.
2. Rising obesity and sedentary lifestyles: Increased intake of processed and energy-dense foods, reduced physical activity, and obesity- particularly after menopause- raise breast cancer risk.
3. Tobacco and alcohol exposure: Tobacco use and harmful alcohol consumption are recognized risk factors, although alcohol-related risk may vary by population and patterns of use.
4. Genetic and familial susceptibility: Research from Kashmir has reported familial, early-onset, and male breast cancer, and has suggested that BRCA1 and TP53 mutations may be more relevant in this ethnic population. A family history of breast or ovarian cancer should prompt specialist genetic counselling.
5. Low awareness and stigma: Many women donot recognize early symptoms or feel hesitant to discuss breast changes. Studies in Jammu and Kashmir report low awareness of symptoms, risk factors, and screening, especially among women over 40.
6. Geographic and access barriers: Kashmir’s rural and mountainous terrain, concentration of specialist cancer services in Srinagar, travel costs, and limited organized screening contribute to delayed consultation and diagnosis.
7. Improved detection and registration: Part of the apparent rise may also reflect greater health-seeking, better diagnostic facilities, and improved hospital reporting. However, this does not explain the consistent reports of advanced-stage disease.

Warning signs and symptoms:

The most common early sign is a painless lump or thickening in the breast or armpit. A lump doesnot hurt in many cases, so absence of pain should never be reassuring.

Seek medical assessment promptly for:

1. A new lump in the breast or underarm.
2. Change in breast size, shape, or contour.
3. Skin dimpling, puckering, redness, or an “orange peel” appearance.
4. Nipple retraction, inversion, scaling, or ulceration.
5. Blood-stained or clear nipple discharge.
6. Persistent breast pain localized to one area, particularly a lump.
7. A sore or wound on the breast that doesnot heal.
8. Swelling in the armpit or around the collarbone.

Most breast lumps are not cancer, but every new or persistent change deserves clinical evaluation. Early cancers are more likely to be cured when treated before spread to lymph nodes or distant organs.

Who is at higher risk?

Some risk factors cannot be changed, while others can be reduced through daily choices and medical care.

Non-modifiable risks include being female, increasing age- especially after 40- a strong family history of breast or ovarian cancer, inherited BRCA1, BRCA2 or PALB2 mutations, early menarche, late menopause, dense breast tissue, and previous chest radiation.

Modifiable risks include overweight and obesity, physical inactivity, harmful alcohol use, tobacco exposure, prolonged use of combined postmenopausal hormone therapy, and delayed childbearing. Notably, about 80% of breast cancers occur in women with no specific risk factor other than female sex and age, which is why awareness and early detection matter for everyone.

Prevention and lifestyle modification

Breast cancer cannot always be prevented, but risk can be meaningfully reduced.

         Maintain a healthy weight; avoid abdominal and postmenopausal weight gain.

         Be physically active for at least 150 minutes per week, combining brisk walking, cycling, or household activity with muscle-strengthening exercise.

         Eat a balanced diet rich in vegetables, fruits, whole grains, pulses, and fibre; limit ultra-processed foods, sugary drinks, and excess red or processed meat.

         Avoid tobacco in all forms and limit or avoid alcohol.

         Breastfeed if possible; exclusive and continued breastfeeding has a protective effect.

         Discuss family planning and hormone therapy with a clinician; avoid unnecessary long-term combined hormone replacement therapy after menopause.

         Know your normal breast appearance and report changes early.

         Women with a strong family history should ask about genetic counselling, risk assessment, and tailored surveillance.

Early detection- What women in Kashmir should do

Early detection has two parts: recognizing symptoms and seeking timely diagnosis, and screening asymptomatic women. WHO recommends breast awareness and prompt clinical assessment for abnormal findings, with organized mammography screening generally targeted at women aged 50-69 where health systems can support it.

For Kashmir, a practical approach should include:

• Monthly breast self-awareness, preferably after menstruation or on a fixed monthly date after menopause.
• Annual clinical breast examination for women from age 30-40, particularly those with risk factors.
• Mammography from age 40-45 for average-risk women where available, and earlier, individualized screening for high-risk women.
• Immediate medical consultation for any suspicious lump, nipple discharge, or skin change.
• Strong referral systems so that women screened in mobile or peripheral camps receive timely biopsy and treatment. Mobile mammography initiatives in Jammu and Kashmir have shown feasibility, but follow-up remains a major weakness.

Diagnosis and treatment in Kashmir

Diagnosis typically begins with clinical examination, followed by imaging- usually mammography and/or breast ultrasound- and a tissue biopsy. Pathology and hormone-receptor testing determine whether the tumour is estrogen-receptor positive, progesterone-receptor positive, HER2-positive, or triple-negative; this directly guides treatment.

Once the diagnosis is confirmed then the disease stage needs to be ascertained which is done with CECT chest and whole abdomen, Bone scan (T99 MDP bone scan) or single stop PET-CT based on the need from case to case. MRI breast has limited role in specific cases where the breast is very dense, or multi centricity is suspected or strong family history of cancers or previously operated breast is present, etc.

Treatment is multidisciplinary and may include:

• Surgery: Lumpectomy or breast-conserving surgery for suitable early tumours, or mastectomy when required. Sentinel lymph-node biopsy is preferred where appropriate because it causes fewer complications than full axillary dissection.
• Radiation therapy: Used after breast-conserving surgery and often after mastectomy in higher-risk disease to lower recurrence risk.
• Chemotherapy: Given before surgery to shrink larger tumours or after surgery to reduce recurrence risk; it is especially important for triple-negative and some node-positive cancers.
• Hormone therapy: Tamoxifen or aromatase inhibitors for hormone-receptor-positive cancers, usually taken for several years.
• Targeted therapy: Drugs such as trastuzumab for HER2-positive disease, commonly combined with chemotherapy.
• Rehabilitation and psycho-oncology: Lymphoedema care, physiotherapy, nutrition, counselling, and support for anxiety, depression, and stigma-related distress.

All these diagnostic and treatment facilities are available in Kashmir leaving no need for our patients to move outside Kashmir for any treatment related to Breast Cancer.

The way forward

Kashmir needs a coordinated response: community awareness in Kashmiri, Urdu and Gojri; school and workplace education; training of ASHA workers and primary-care staff; mobile mammography with reliable referral; a population-based cancer registry; and psycho-social support for patients and families. The goal should be simple: no women should delay care because of fear, stigma, distance, or lack of information.

Breast cancer is serious, but it is not silent or untreatable disease. A lump noticed today and examined this week can make the difference between a curable early cancer and an advanced illness. Every woman in Kashmir should know her breasts, report changes without delay, and encourage the women around her to do the same.

The writer is Director Surgical Oncology, Breast & Colorectal Cancers, New City Hospital, Tengpora Bypass, Srinagar