When it comes to breast cancer, the landscape of "prevention" is shifting from a one-size-fits-all approach to highly personalized risk management. The latest National Comprehensive Cancer Network (NCCN) guidelines offer a clear roadmap for staying ahead of the curve.

The Reality in India: 2026 Statistics

The latest data from the Indian Council of Medical Research (ICMR) and recent 2026 reports present a sobering call to action:

•  The Burden: Breast cancer remains the #1 cancer among Indian women, accounting for 27% of all female cancers.

• The Age Gap: Unlike the West, where the median age is 62, Indian women are diagnosed 10–15 years earlier. Approximately 16–20% of new cases are now in women under 40.

• The Survival Challenge: Due to late-stage presentation, the 5-year survival rate in India hovers around 60%, compared to over 90% in high-income countries. This is largely because 57% of cases are diagnosed at Stage III or IV.

• Incidence Hotspots: Cities like Hyderabad (54 per 100,000) and Delhi (41 per 100,000) report rates significantly higher than the national average of 26.6.

Adapting NCCN Standards for Indian Patients

Given the earlier onset of disease in India, the 2026 NCCN recommendation to begin risk stratification at age 25 is particularly critical.

• Customized Screening: For average-risk Indian women, annual screening should begin at age 40. However, for those with a family history, we often recommend starting 10 years earlier than the age of the youngest affected relative.

• The Density Factor: Indian women often have denser breast tissue. I prioritize 3D Mammography (Tomosynthesis) as it reduces the high "false negative" rate common in 2D scans for dense breasts.

Lifestyle & Environmental Factors in India

Recent 2025/26 ICMR studies have identified specific modifiable risks unique to our context:

1. Central Obesity: Elevated waist-to-hip ratios are a significant driver for post-menopausal breast cancer in India.

2. Physical Inactivity: High-intensity movement for 150+ minutes a week has been shown to modulate insulin-like growth factors, a known cancer pathway.

3. Metabolic Health: Irregular sleep patterns and elevated stress levels are now recognized as contributing factors in recent systematic reviews.

A Surgeon's Final Word In India

The greatest barrier to prevention is often social stigma. We must move from "feeling for a lump" to "screening for the invisible." Early detection at Stage I carries a survival rate of nearly 99%. Your lifestyle lowers your baseline risk but your screening schedule should be tailored to your unique genetic and family profile.

Dr Reena Anto Johnson

MBBS, FCPS (General Surgery)

MUHS Breast Fellowship 

Trained at TATA Memorial Hospital

Consultant Breast Surgeon at Renatus Cancer Centre

ICMR has published 17 dietary guidelines for Indians with an aim to help make informed choices to maintain good health and avoid malnutrition in any form. These guidelines also prevent chronic lifestyle disorders like diabetes, hypertension, IBS etc. From 17 ICMR guidelines, cancer preventive guidelines are as mentioned below.

Guideline 1: Eat a variety of foods to maintain a balanced diet. Plan your meals to include all food groups to make sure you get all essential nutrients in the right proportions.

Guideline 3: Ensure exclusive breast feeding for the first 6 months and continue breast feeding for 2 years and beyond. Breast feeding not only ensures the baby's health but also reduces mothers risk of breast, ovarian and endometrial cancer.

Guideline 6: Eat plenty of vegetables and legumes: Vegetables and legumes are packed with fibre which have cancer preventive effect. Moreover, polyphenols in vegetables boost our immunity thus preventing cancer.

Guideline 7: Use oil/fats in moderation; chose a variety of oilseeds, nuts, nutricerals and legumes to meet daily need of fats and essential fatty acids (EFAs): Fats are essential for overall good health, but in taken in excess quantities has harmful effects. Good quality fats like walnuts and flaxseeds, which are rich in omega 3 fatty acids,  when taken in moderation have been proven to have cancer preventive effect.

Guideline 8: Obtain good quality protein and essential amino acids through appropriate food combinations and avoid protein supplements for body building. Natural proteins with high biological value like eggs, milk, and curd are best as they are readily absorbed in our body as compared to synthetic protein powders.

Guideline 9: Adopt a healthy lifestyle to prevent abdominal obesity, overweight and overall obesity. Excess body weight or body fat invites a lot of metabolic disorders which if not corrected can lead to cancer.

Guideline 10: Be physically active and exercise regularly to maintain good health. Regular physical activity makes sure our body is functioning in the best possible way. Lack of exercise makes one vulnerable to various metabolic diseases.

Guideline 15: Minimize consumption of high fat, and ultraprocessed foods (UPFs): UPFs are carcinogenic and induce cancer.

Guideline 17: Read information on food labels to make informed and healthy food choices. Reading labels to make sure we are avoiding UPFs and other carcinogenic ingredients is best practice to prevent cancer. 

Purva Sharma

Onco-dietitian

Consultant at Renatus Cancer Centre

Mental health is a critical yet often overlooked component of oncology care. While cancer treatment primarily focuses on the patient’s physical health, the psychological well-being of both patients and their caregivers significantly influences treatment adherence, coping, and overall quality of life. Cancer diagnosis and treatment often bring prolonged uncertainty, emotional distress, and practical challenges. In this context, caregivers usually family members play a central role in providing emotional, physical, and logistical support. However, the sustained demands of caregiving can lead to significant caregiver burden.

Caregiver burden in oncology refers to the physical, emotional, social, and financial strain experienced by individuals who care for cancer patients. Caregivers frequently manage medication schedules, hospital visits, symptom monitoring, and emotional reassurance while simultaneously balancing personal responsibilities. Over time, this can lead to exhaustion, anxiety, depressive symptoms, sleep disturbances, and feelings of helplessness. In many oncology settings, caregivers may neglect their own needs while prioritizing the patient’s care, which further exacerbates stress and burnout.

Addressing caregiver burden is essential because caregiver well-being directly affects patient outcomes. When caregivers experience overwhelming stress, their ability to provide effective support may decline. Therefore, integrating caregiver support into oncology care is an important aspect of holistic treatment.

Five Tips to Manage Caregiver Burden

1.       Acknowledge Emotional Responses: Caregivers should recognize that feelings of fear, frustration, sadness, and fatigue are natural responses to caregiving. Accepting these emotions rather than suppressing them can reduce psychological distress.

2.       Seek Social and Professional Support: Connecting with family members, support groups, or mental health professionals can provide emotional validation and practical guidance in coping with caregiving challenges.

3.       Prioritize Self-Care: Maintaining adequate sleep, balanced nutrition, and short periods of relaxation or physical activity can significantly improve resilience and prevent burnout.

4.       Share Responsibilities: Caregiving should not be a solitary responsibility. Delegating tasks among family members or seeking community support can help distribute the workload.

5.       Access Psychoeducation and Resources: Learning about the illness, treatment process, and coping strategies can help caregivers feel more prepared and reduce anxiety associated with uncertainty.

Parnavi Kherade 

Onco Psychologist

Consultant at Renatus Cancer Centre

Within the quiet rhythm of a woman’s body lies a remarkable awareness. Often, the body whispers before it cries out. In the case of Breast Cancer, these whispers can appear as subtle changes—gentle signals asking to be noticed, understood, and addressed. One of the earliest signs may be a new lump or area of thickening in the breast or underarm. It may arrive silently, without pain, and yet it carries significance. While many breast lumps are harmless, a new or persistent one deserves attention and professional evaluation.

Sometimes the signs are seen rather than felt. A breast may change its natural shape or size, or the skin may reveal delicate alterations—dimpling, redness, or a texture resembling the peel of an orange. These changes are the body’s quiet language, asking us to look a little closer. The nipple too may tell a story. A sudden inward turn, unusual discharge, or dryness and scaling around the nipple area may serve as early signals that something beneath the surface requires care. Occasionally, swelling or a small lump in the underarm or near the collarbone may appear, reflecting changes in nearby lymph nodes.

Recognising these signs is only one part of the journey. Medical science also guides us through structured screening and prevention. According to the 2026 recommendations from the National Comprehensive Cancer Network, women at average risk are encouraged to begin annual mammographic screening from the age of 40. Women with higher risk—such as those with strong family histories or genetic predispositions—may benefit from earlier and more comprehensive screening.

Similarly, the American Society of Clinical Oncology and the European Society for Medical Oncology emphasize a thoughtful, risk-based approach to screening and early detection. Their guidance reminds us that vigilance, knowledge, and timely evaluation are powerful allies in protecting women’s health. It is important to remember that breast cancer does not always announce itself loudly in its earliest stages. Often, it begins with the faintest of signals. By learning to recognise these subtle changes, seeking regular screenings, and honoring the body’s messages, women empower themselves with the greatest gift of all—the chance for early detection and timely care. In listening closely to these quiet signs, we do more than observe our health; we safeguard our future.

Dr Reena Anto Johnson

MBBS, FCPS (General Surgery)

MUHS Breast Fellowship 

Trained at TATA Memorial Hospital

Consultant Breast Surgeon at Renatus Cancer Centre

References

1.    National Comprehensive Cancer Network (NCCN). Breast Cancer Screening and Diagnosis
Guidelines (2025-2026 updates).

2.    NCCN Guidelines Insights: Breast Cancer Screening recommendations (annual mammography, risk-based screening).

3.    European Society for Medical Oncology (ESMO). Clinical Practice Guidelines for Breast Cancer (Early and Metastatic).

4.    NCCN Patient Guidelines: Role of screening in detecting cancer before symptoms.

What Is Oncophysiotherapy?

Oncophysiotherapy is a specialized branch of physiotherapy that focuses on the physical rehabilitation and functional recovery of cancer patients before, during, and after treatment. In simple words, it helps patients regain strength, movement, endurance, and confidence in their body throughout the cancer journey.

Cancer treatments such as surgery, chemotherapy, radiation therapy, prolonged bed rest, and hospitalization can affect the body in many ways. Patients may experience:

• Severe fatigue

• Muscle loss and weakness

• Reduced mobility

• Breathing difficulty

• Joint stiffness

• Poor balance

• Pain and swelling

• Reduced physical endurance

These physical changes can significantly affect quality of life, independence, and emotional well-being. An oncophysiotherapist helps manage these challenges through personalized rehabilitation programs designed according to the patient’s condition, treatment stage, and physical capacity.

Why Is Oncophysiotherapy So Important?

One of the biggest misconceptions about cancer recovery is that patients should only rest. Rest is important but excessive inactivity can actually worsen weakness, stiffness, fatigue, and loss of physical function. This is why modern cancer care increasingly includes rehabilitation as an important part of recovery. Physiotherapy helps patients stay physically active in a safe and structured way, which can improve both recovery and overall well-being.

And sometimes, recovery is not about doing something extraordinary.

Sometimes it is simply about:
walking comfortably again,
climbing stairs without exhaustion,
breathing more easily,
or feeling confident enough to move without fear.

How Oncophysiotherapy Helps Cancer Patients

Reduces Cancer-Related Fatigue

Cancer-related fatigue is not the same as normal tiredness. Many patients feel physically and mentally exhausted even after resting. Research shows that supervised exercise and rehabilitation can help improve energy levels, stamina, and overall physical functioning during and after treatment.

Improves Mobility and Independence

After surgery or prolonged treatment, patients often become hesitant to move because of pain, weakness, or fear of injury. Gradual rehabilitation helps restore mobility safely and improves confidence in performing daily activities independently. Even small improvements in movement can make a big difference in a patient’s daily life.

Supports Recovery After Surgery

Cancer surgeries may lead to stiffness, scar tightness, reduced range of motion, breathing limitations, and weakness. Physiotherapy helps improve flexibility, restore movement, reduce complications, and support safer recovery after surgery. This is especially beneficial after breast surgeries, chest surgeries, abdominal procedures, and orthopedic cancer surgeries.

Helps Manage Pain, Stiffness, and Swelling

Some patients develop swelling after lymph node removal or radiation therapy, commonly known as lymphedema. nOthers experience muscle tightness, postural issues, or chronic pain during recovery. Through specialized exercises, movement therapy, posture correction, and lymphedema management techniques, oncophysiotherapy can help patients feel more comfortable and physically functional.

Improves Breathing and Physical Endurance

Patients undergoing chest surgery, radiation therapy, or prolonged hospitalization may experience reduced lung capacity and breathlessness. Breathing exercises and pulmonary rehabilitation help improve lung function, oxygenation, endurance, and overall activity tolerance. Sometimes patients don’t realize how much their breathing has changed until they finally begin to feel comfortable moving again.

When Should a Patient Start Oncophysiotherapy?

The answer is — much earlier than most people think.

Patients can benefit from physiotherapy:

• Before starting cancer treatment

• During chemotherapy or radiation therapy

• After surgery

• During recovery and survivorship

• When experiencing fatigue, weakness, swelling, or difficulty walking

• Even during supportive or palliative care

Early rehabilitation often leads to better physical outcomes, improved recovery, and better quality of life.

Evidence Behind Oncophysiotherapy

Over the last few years, cancer rehabilitation has gained significant recognition worldwide. Research shows that physiotherapy and exercise-based rehabilitation can help reduce cancer-related fatigue, improve strength and mobility, enhance physical functioning, and support emotional well-being. Because of these benefits, international cancer care guidelines now recommend supervised physical rehabilitation as an important part of comprehensive cancer care.

Conclusion

Cancer treatment affects much more than just the disease itself. It affects how a person moves, breathes, functions, and experiences daily life. This is why oncophysiotherapy is becoming an increasingly important part of modern cancer care. By combining evidence-based rehabilitation with personalized physical support, oncophysiotherapy helps patients improve strength, mobility, endurance, breathing, and overall quality of life throughout treatment and recovery.

At the same time, rehabilitation is not only about physical exercises. It is also about helping patients feel more confident in their body again — one movement, one breath, and one step at a time.

Dr Alifiya Sadikot

Consultant Onco Physiotherapist at Renatus Cancer Centre

Oropharyngeal squamous cell carcinoma is a cancer arising from the oropharynx (back of the mouth) which includes the tonsils, base of tongue, soft palate, and posterior pharyngeal wall. Over 90% of oropharyngeal cancers are squamous cell carcinomas. HPV has been found to cause cancer of the genital organs in both men and women, oropharynx, as well as benign conditions like genital and cutaneous warts.

Epidemiology and Risk Factors  

The recent analyses of cancer registry data show dramatic increases in the incidence of oropharyngeal carcinomas during the past 15–20 years as the incidence of oral cavity carcinomas has remained constant or declined. 

HPV+ OPSCC typically affects younger patients, often nonsmokers. HPV-negative disease still occurs, mainly in older adults with heavy smoking and alcohol history.

Oral HPV infection was independently linked to factors such as age, sex, number of sexual partners and the current number of cigarettes smoked per day.(19) In recent times it was also found to be linked to alcohol, genetic polymorphisms. Smoking is known to decrease the clearance of oral HPV infections.

The incidence of human papillomavirus-associated oropharyngeal cancer (HPV+OPSCC) is continuing to rise over the coming decades until the benefits of gender-neutral prophylactic HPV vaccination begin to become manifest.  

 Clinical Presentation  

High-risk HPV infections are asymptomatic, and most persons exposed to HPV will clear the infection and never develop carcinoma.

Common symptoms include a painless neck mass, sore throat, dysphagia, otalgia, trismus, and voice changes. Primary tumors can be subtle, especially at the base of tongue.  Importantly, OPSCC is often detected at an advanced stage owing to a lack of symptoms in the early stages; therefore, a need exists to identify and validate possible diagnostic biomarkers to aid in earlier detection.

Diagnosis and Staging  

Diagnosis requires biopsy of the primary or node, with p16 testing to determine HPV status. Workup includes CT/MRI neck, PET-CT, and EUA with biopsies. 

Prevention, Prognosis and Management  

With the advent of vaccines that can prevent HPV infection, the World Health Organization has made eliminating HPV and its related cancers a global health priority. Treatment decisions depend on exact staging , patient fitness , smoking history  and surgical resectability.

Early stages can be treated with surgery or RT with post op adjuvant RT or CT RT.

Locally advanced stages are treated with concurrent CTRT or induction chemo.

Recurrence and metastasis are treated with immunotherapies.

HPV+ OPSCC has markedly better outcomes, with 3-year survival ∼85-90% for early stage vs ∼60% for HPV-negative.  Because HPV+ patients are younger and live longer, treatment de-escalation trials are ongoing to reduce long-term toxicity.

Dr Saumya Verma 

MBBS, DNB

Cancer treatment focuses heavily on the body;  chemotherapy, radiation, surgeries, medications, scans, and physical recovery. However, one of the most overlooked aspects of cancer care is the emotional and psychological impact that treatment can have on a person’s life.

Many patients expect physical side effects such as fatigue, nausea, hair loss, or pain. What often comes unexpectedly are the emotional changes that silently accompany the cancer journey.

Common Emotional Side Effects of Cancer Treatment

1.       Anxiety and Fear

Many patients constantly worry about:

• Treatment outcomes

• Disease progression

•  Fear of recurrence

•  Family and future uncertainties

This may lead to restlessness, overthinking, panic attacks, or sleep difficulties.

2.       Depression and Emotional Exhaustion

Long-term treatment can leave patients feeling emotionally drained, hopeless, or disconnected from daily life. Some may lose interest in social activities, work, or hobbies they once enjoyed.

3.       Changes in Self-Image

Hair loss, weight changes, surgical scars, or physical weakness can affect confidence and body image, making patients feel uncomfortable or withdrawn socially.

4.       Emotional Exhaustion

Cancer treatment often requires repeated hospital visits, investigations, medications, and lifestyle adjustments. Over time, many patients experience emotional fatigue.

5.       Isolation and Relationship Stress

Cancer can sometimes make patients feel misunderstood or emotionally alone. Families and caregivers may also experience stress and burnout during the treatment journey.

6.       Fear of Recurrence

Even after successful treatment, many survivors continue living with the fear that cancer may return. Routine scans, follow-ups, or minor physical symptoms can trigger intense anxiety. This fear is especially common during the transition from active treatment to survivorship.

Why Many Emotional Symptoms Go Unnoticed?

Emotional distress in cancer care is often overlooked because:

• Patients prioritize physical survival

• Families focus mainly on medical treatment

• Emotional struggles may be normalized

• Patients fear being judged as “weak”

• Mental health conversations still carry stigma

As a result, many individuals suffer silently while trying to cope with immense emotional pressure.

Why Emotional Health Matters?

Emotional distress during cancer treatment is common, but often ignored because the primary focus remains on physical recovery. Unaddressed emotional struggles can affect quality of life, coping ability, and even treatment adherence.

Psycho-oncology support helps patients:

• Manage anxiety and stress

• Build emotional resilience

• Improve coping skills

• Express emotions safely

• Enhance overall well-being

Supportive therapies such as counselling, CBT, mindfulness, and family support can make a significant difference during treatment.

SIMPLE BEHAVIOURAL CHANGES THAT CAN HELP DURING CANCER TREATMENT

Small daily behavioural changes can significantly improve emotional well-being and coping during cancer treatment. Some helpful practices include:

• Maintaining a simple daily routine to create stability and reduce mental overwhelm.

• Engaging in light physical activity such as short walks or stretching, as advised by the doctor.

• Practicing relaxation techniques like deep breathing, mindfulness, or meditation.

• Expressing emotions through journaling, art, prayer, or talking to a trusted person.

• Staying socially connected with supportive family members and friends instead of isolating oneself.

• Limiting excessive internet searches about cancer, which may increase anxiety and fear.

• Focusing on small achievable goals each day rather than trying to control everything at once.

• Maintaining healthy sleep habits and reducing screen time before bed.

• Participating in enjoyable activities or hobbies whenever possible to improve mood and emotional balance.

• Seeking psychological support early when feelings become overwhelming.

These small but consistent behavioural changes can help patients feel more emotionally supported, empowered, and resilient throughout their cancer journey.

HEALING BEYOND MEDICINE

Cancer care is not only about treating the disease — it is also about caring for the person going through it.

Recognizing and addressing emotional side effects is an important step toward holistic healing. Seeking psychological support is not a sign of weakness, but a part of comprehensive cancer care.

At Renatus Cancer Centre, we are committed to supporting both the physical and emotional well-being of every patient and caregiver throughout the cancer journey.

Parnavi Kherade 

Onco Psychologist

Consultant at Renatus Cancer Centre