CHENNAI: Tina Knowles—renowned American businesswoman, fashion designer, and perhaps most affectionately known as the mother of singer Beyoncé Giselle Knowles-Carter—shares a deeply personal chapter in her recently released memoir. She opens up about a startling diagnosis: stage 0 breast cancer. Unfamiliar with the term, she found herself asking, “What is stage zero?”—a stage so early, it often goes unnoticed.
Reflecting on her experience, Tina expressed that had she not missed her routine mammogram, she might have caught it even sooner. Her story stands as a heartfelt reminder of the quiet power of early detection—and a call for greater awareness and commitment to regular breast cancer screenings, not only in America but around the world, including India, where this deadly disease is alarmingly on the rise.
As noted in a recent National Geographic feature, most people are familiar with cancer stages one through four, but stage 0 cancer is lesser-known, despite its importance in early detection and treatment. This early stage often lacks the visibility of more advanced cancer and can go undiagnosed without regular screenings.
What Is Stage 0 Cancer?
Stage 0 means abnormal cells have been found in the body, but they haven’t yet become invasive cancer. These cells haven’t spread beyond their point of origin or into surrounding tissues.
These abnormal cells, typically too small to form tumors, won't often show up on imaging like MRIs or ultrasounds. It’s commonly found in external tissues, especially breast tissue, through routine mammograms.
In medical terminology, 'stage 0' is often called carcinoma in situ (Latin for “in place”), and a prefix like (in) lungs, cervix, or GI tract may indicate the site of the abnormal cells, such as adenocarcinoma in situ.
"If detected at this stage, cancer can potentially be completely cured, requiring minimal treatment at a significantly lower cost," says noted oncologist Dr Narayanankutty Warrier, Medical Director, at MVR Cancer Centre and Research Institute, Kozhikode.
In Breast Cancer
In the breast, stage 0 is known as ductal carcinoma in situ (DCIS), referring to abnormal cells in the milk ducts. DCIS only progresses to higher cancer stages if the cells break through the ducts and spread.
Comparison with Later Stages
Stage I: Cancer begins invading nearby tissue.
Stage II: Tumor grows larger; cancer may be in nearby lymph nodes.
Stage III: Greater lymph node involvement and further spread.
Stage IV: Metastatic cancer, spread to other organs—harder to treat and more dangerous.
Breast and Cervical Cancer Screening: The India Picture
India faces significant challenges regarding the screening, diagnosis, and treatment of breast cancer and cervical cancer, two of the most common cancers among women in the country.
Breast cancer is the most common cancer among women in India, accounting for approximately 27% of all female cancer cases, followed by cervical cancer. Cervical cancer has an estimated 123,000 new cases and 67,000 deaths annually, with a prevalence rate of 22.9 per 100,000 women—higher than the global average.
While the age-standardised incidence rate (ASIR) of breast cancer in India is currently 25.8 per 100,000 women, this number is expected to rise due to increasing urbanisation, lifestyle changes, and improved awareness and detection.
However, Early detection rates are relatively low, and breast cancer is often diagnosed at an advanced stage due to a lack of widespread screening programs and awareness. Breast cancer screening programs like mammography and clinical breast exams are not widely accessible to all women, especially in rural areas. Although awareness about self-breast examination (SBE) is slowly increasing, formal screening infrastructure, especially in rural and underserved regions, remains limited.
Likewise, mammography is recommended for women aged 50 and above, this is also not as widely available or affordable for the general population, particularly in lower-income groups and rural settings.
Unfortunately, the treatment, even after diagnosis, is mostly available in urban centers, including surgery, chemotherapy, radiation, and targeted therapies. So treatment access remains a challenge for women in rural and economically disadvantaged areas, and adding the woes, the cost of treatment, particularly the most effective ones like targeted therapies and immunotherapies.
While the public health insurance schemes like Ayushman Bharat aim to provide coverage for cancer treatment, these benefits are still being rolled out and are often limited by infrastructure.
Both breast and cervical cancers suffer from poor awareness in rural and underserved areas, leading to late-stage diagnoses. Additionally, in many regions, social stigma and cultural factors discourage women from seeking preventive care, screening, or treatment, especially for cervical cancer.
While India has made strides in cancer care, significant challenges remain in terms of access to screening, early diagnosis. Though public health initiatives and government programs are playing a vital role in improving access to care, there is still a long way to go, particularly for women in rural areas and lower-income groups.
Importance of Early Detection
Though stage 0 in cancer may remain stable, it can evolve into invasive over months or years. Patients are often monitored closely, but in some cases, doctors may recommend localised treatment, like radiation or surgery, to remove the cells before progression.
Early treatment is less invasive and more effective than waiting until cancer advances. Individuals with family history or higher risk should consider earlier and more frequent screenings.
Since stage 0 breast cancer has a survival rate close to 99% when caught and treated early, doctors emphasise that it’s the most curable and favorable stage, making early detection critical.