Breast cancer is a major problem in India and it is increasing day by day. On an annual basis, about 200,000 women are diagnosed with breast cancer in India every year. The second problem is the growing number of young breast cancer patients in India as many young women under the age of 35 are being diagnosed with breast cancer these days.
In the Western population, breast cancer is more common in the elderly but more and more young women in India are diagnosed with breast cancer and unfortunately, early breast cancer accounts for only about 40% of all breast cancers in India, while it is 80% or more. Western nations because they are more conscious. They go for mammography and regular screening tests regularly but in India, women are very reluctant to express their problems because they do not talk much about it or care enough to get screening done, preferring to delay it. Possible and only when they have an advanced tumor do they come for a check-up.
In an interview with HT Lifestyle, Dr. Rajeshwar Singh, Director of Medical Oncology, Paras Hospital, Panchkula, shared, “Breast cancer is not a single disease, it is a disease affecting the breast. We have positive hormone breast cancer, HER2 / neu and triple negative breast cancer. Of these, for breast cancer caused by female hormones, we offer special type of hormone treatment where female hormones are suppressed and in such cases the treatment is effective. Traditionally, we used to give chemotherapy to all patients with early breast cancer. It was not possible to decide which patients needed chemotherapy and which categories of patients could avoid chemotherapy. Chemo is usually given to ensure that the cancer does not recur.
He explained, “Anyone who goes through chemotherapy has to face some things – a side effect because chemotherapy is a systemic drug and once it goes into a vein it goes to all the cells in the body. It kills the cancer cells but also affects the normal cells of the body and Because people have side effects such as loose motion, vomiting, hair loss, and anemia. Not all patients experience side effects, but some do. All of these side effects occur in breast cancer patients undergoing chemotherapy, if prognostic. If the test score is less than 15, those patients have a lower risk of breast cancer and they do not need chemotherapy and can be treated with hormone therapy or radiotherapy. Nowadays, we have a modality through which we can afford We can decide what the patient needs or not. ”
However, he said that with the development of science came the development of cancer treatment. She points out that with the introduction of prognostic tests such as oncotypods and canned breasts, we can now find out at what early stage breast cancer patients benefit from chemotherapy. In prognostic tests, we sample tumors and analyze proteins to detect recurrence. The tests give each patient a unique recurrence score. If the score is above 15.5 there is a high risk of recurrence and if it is below 15.5 the risk of cancer recurrence is low. We want to give chemotherapy only to patients with high risk of breast cancer recurrence and not to patients with low risk. There is no benefit in giving chemotherapy to low-risk breast cancer patients because hormone therapy is given to all patients and we want to see how much the patient can avoid chemotherapy just by giving hormone therapy. ”
According to Dr. Ashish Jakhetia, a surgical oncologist at Gitanjali Hospital, “The standard treatment for early-stage breast cancer is good surgery, usually breast protection surgery, followed by radiotherapy and chemotherapy. If the tumor was more than 1 or 2 centimeters long, the patient would have to undergo chemotherapy. However, this treatment method has changed. We are now in the age of precision medicine, where every patient’s condition is different. This one size fits all approach. The biology and tumor of each patient is different. We cannot apply the same formula / instructions to all or treat each patient with a blanket. This is now possible due to advances in molecular diagnosis. Once the molecular analysis is done, there are many risk predictions or prognostic tests like Oncotype DX, Mammaprint, Endopredict and some new and affordable Indian alternatives like ‘CanAssistBreast’ which gives good risk prediction scores in early breast cancer patients.
He added, “In early-stage breast cancer patients, about 70% of patients fall into the low-risk group, which means these patients can safely avoid chemotherapy because they have a lower risk of cancer recurrence. We are recommending these tests regularly and patients undergoing these tests and those who can avoid chemotherapy are very happy because there are many side effects associated with chemotherapy such as reproductive problems, hair loss, weakness, nausea, neutropenia. There are many patients. Who can safely avoid chemotherapy if their risk of recurrence is low.According to the estimated analysis, I can say that these tests should be offered to at least 10-15000 female patients in India as they may be able to safely avoid chemotherapy.
We all know that chemotherapy is a toxic drug and its side effects like wakawaki and alopecia (hair loss) but Dr. Surendra Beniwal, Professor and Head of Department, Medical Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute of Bikaner gave consolation. For early stage breast cancer patients, there is the option of avoiding chemotherapy. He added: “There are many tests available today that indicate the possibility of recurrence of breast cancer in the early stages and the need for chemotherapy. Based on that, it can be decided whether the patient should undergo chemotherapy or not. These tests perform a molecular test on breast cancer-affected tissues and then try to rule out whether chemotherapy will help these patients. In some types of breast cancer, especially hormone receptor positive, we can avoid chemotherapy and give only one or two pills per day with equal or better effects and very few side effects. With some of these drugs we can avoid chemotherapy with an equal or better chance of survival than with chemotherapy. We recommend doing all of these tests for hormone receptor positive early breast cancer patients. So we can avoid chemotherapy and ensure a better quality of life for these patients. ”
Dr. Surendra Beniwal said that chemotherapy is essential to prevent recurrence of the disease, adding that doctors should give the same treatment to all breast cancer patients in the early stages or advanced stages of breast cancer. However, with the availability of these tests, doctors can now personalize treatment. “The most frightening cause of chemo is alopecia (hair loss), whether it is male or female,” he said. For women in particular, this is a more frightening side effect because hair loss is a very painful condition for a woman and her family. Due to these side effects, women are not allowed to go out of the house or engage in any social work. Another side effect is vomiting, stomatitis of the mouth due to not being able to eat or drink properly. Another side effect is that chemotherapy itself can sometimes cause secondary cancer. Depending on the chemotherapy given to the patient after 4-5 months of treatment, different cancers like blood cancer can occur. We do not recommend chemotherapy to all patients to avoid these side effects.