Mumbai: Breast TB on the rise, says medical experts

The TB bacterium easily infects those who have low immunity and don’t receive adequate nutrition. Representation pic

All lumps in the breast are not cancerous, say surgical oncologists, who are seeing an increase in breast tuberculosis (TB) cases among young professionals and elderly women. Experts worry that this is being underreported due to a lack of awareness and delay in diagnosis.

Dr Meghal Sanghavi, a surgical oncologist at Wockhardt Hospital in Mumbai Central, said, "Over the past few months, breast TB cases have come to light. In most cases, there was a delay in diagnosis and subsequent line of treatment, as patients would presume it to be an infection, which was not the case."

Dr Meghal Sanghavi, surgical oncologist, Wockhardt Hospital, Mumbai Central

According to Dr Sanghavi, the TB bacterium easily infects those who have low immunity and poor nutrition. She referred to a case of a patient in her mid-thirties, a working professional with erratic food habits. "Her nutrient intake was insufficient and she was also diabetic. A lump on her breast went almost undiagnosed for a few months and with multiple lines of treatment before she was diagnosed with breast TB. She was put on antibiotics, which gave her temporary relief, during the initial period, but tuberculosis went undetected."

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Dr Sanghavi added, "Taking antibiotics before the actual diagnoses of the ailment may act as second-line therapy for TB and they partially work on the bacteria, which gives a false sense of healing. And as antibiotics are not prescribed for over a period of five week, the bacteria once again comes active with the stoppage of antibiotics, and it spreads, unless the patient is put on AKT treatment for tuberculosis, which varies from six to nine months."

Oncologists are seeing cancers associated with tuberculosis in nodes in the neck or armpit. Representation pic

This was the case with Dhara Jain, 35, a law graduate and company secretary from Byculla, who learnt this the hard way.

She told mid-day, "I had a lump in my breast, which was diagnosed for the first time in March 2021. It started as a small boil, but it soon became very painful and impacted my daily routine. I was diabetic, and initially, most of the physicians and gynaecologists I visited suspected it to be cancerous, but all my test reports were negative. I had spent over Rs 1.50 lakh on treating something that was unclear about."

Dr Kedar Toraskar, pulmonologist and TB expert

"It was my sonologist who first suspected it to be a breast tuberculosis lump and advised me to meet a certain expert, who was able to detect and diagnose the ailment correctly. I was put on anti-TB medicine and being diabetic, instead of six months, I have been put on treatment for nine months. Today, I am back to my routine and even playing with my three-year-old child without any hardship," said Jain.

She added, "I would advise youngsters not to panic and get the correct diagnosis done before pumping your body with antibiotics and to trust that all lumps are not cancerous. I am thankful to Dr Meghal Sanghavi and Dr Kedar Toraskar for correctly diagnosing my ailment and treating me."

Asked what happens if breast TB goes untreated for a long period, Dr Sanghavi said it could lead to breast distortion and pain. "Moreover, the lump can rupture, leading to a poor-healing wound and can cause sinus tracts and fistulas which are non-healing and these infections mainly affect the quality of life and daily routine. Also, the risk of drug-resistant tuberculosis cannot be ruled out," she said.

Dr Sanghavi added that she had to carry out surgical interventions to treat some patients' lumps as medicines were not working out directly. "We are also seeing cancer associated with tuberculosis in nodes in the neck region or armpit area, and if the node test negative for cancer and positive for tuberculosis, we need to treat the patient accordingly," she said.

Dr Kedar Toraskar, pulmonologist and TB expert, said, "With the easy availability of GeneXpert testing and the MGIT (mycobacteria growth indicator tube) test, it has become easy to diagnose TB faster, and the pickup rates have increased, and it also helps to know if the tuberculosis is drug-resistant or drug-sensitive and, accordingly, we can plan the line of treatment."

Dr Toraskar added, "We must understand that in India, TB is endemic and breast TB usually tends to be around 5 to 7 per cent of all TB cases, whereas the same in western countries would be less than 1 per cent. The chances of a lactating mother getting a breast infection is high as they are low on immunity. The breast is more vascular with more blood supply. Also, we are seeing cases of malignancy and TB in certain patients. Early and correct diagnosis help in faster recovery."

Underreporting

Dr Sanghavi quoted the Global Tuberculosis Report dated October 27, 2022, which states, "With 28 per cent cases, India was among the eight countries accounting for more than two-thirds (68.3 per cent) of the total TB patient count. India accounted for 36 per cent of global TB-related deaths among HIV-negative people." India was among the three countries that accounted for the most reduction in 2020 (67 per cent of the global figure), the other two being Indonesia and the Philippines."

Another problem is underreporting of cases, which is a problem in India; the country is among the top five contributors (24 per cent) followed by Indonesia (13 per cent), the Philippines (10 per cent), Pakistan (6.6 per cent) and Nigeria (6.3 per cent). Reductions in reported TB cases suggest an increase in people with undiagnosed TB. The report reiterated its call for countries to put in place urgent measures to restore access to essential TB services.

28
Percentage of global TB cases in India

Important indications

A tuberculosis lump
. Starts as a small boil/defused lump
. Causes heaviness or pain in breast
. May liquify or rupture and release pus
. Is associated with loss of appetite, low-grade fever, weight loss

A cancerous lump
. Is painless, unless in late stages
. It is well-defined and hard in consistency
. May involve the skin but does not liquify
. Is not be associated with loss of appetite, low-grade fever initially