Breast Cancer Management needs to leverage the benefits of Clinical breakthroughs by creating awareness

With some 1,78,000 new cases being diagnosed every year in India beating Breast Cancer with Early Detection, Regular Checkup and Advanced Treatments become very important

Based on current trends, breast cancers are rising alarmingly in the country among women and it contributes to nearly 15 per cent of all cancers. On the occasion of World Cancer Day, which is observed to raise awareness and to encourage its prevention, detection, and treatment, oncologists give a mantra for its efficient management- ‘Be Breast Aware.’ Going for regular breast cancer screening helps in early detection and if diagnosed it can be followed up with timely advanced treatments. It is evident that awareness and screening can help in detecting a large number of breast cancers at an early stage. Breast cancer is currently the most common cancer among Indian women, both in terms of incidence as well as mortality.

According to a study by Globocon 2020, In India, every four minutes a woman is diagnosed with breast cancer. With some 1,78,000 new cases being diagnosed every year, the incidence of breast cancer has overtaken cervical cancer to become the most common cancer in Indian women. It is very alarming that for every two women diagnosed with breast cancer, one dies of it. The ICMR’s National Cancer Registry Programme Report 2020 projected a 12% rise in cancer cases by 2025. As per estimates, there will be about 15.7 lakh cancer cases by 2025, based on current trends. Among women, breast cancers are estimated to contribute 14.8%.

Elaborating on the clinical aspects of Breast Cancer on the occasion of World Cancer Day, Dr. Bhawana Awasthy, Chief- Medical & Clinical Oncology, Indian Spinal Injuries Centre said, “Cancer that develops in breast glands or ducts is called breast cancer. A lump in the breast, bloody or straw-coloured nipple discharge, recent nipple inversion, ulceration or destruction of the nipple, dimpling of skin and thickening of skin to give an appearance of orange peel are some of the symptoms of breast cancer. While identifying these signs is important , regular mammography picks up cancers even before these symptoms. Meet your doctor for a breast examination and screening advice before the disease becomes apparent. Remember, breast cancer is curable if detected early.”

Dr. Suman Mallik, Clinical Director – Senior Consultant & HOD Radiation Oncology, Narayana Superspeciality Hospital, Howrah said, Confirmation of diagnosis of breast cancer usually requires a needle biopsy, which can be performed at the OPD 10-15 minutes after the mammogram is done. “We initially go for ultrasound, mammogram and sometimes MRI in special situations to detect early disease. Patients with larger lumps, those having enlarged glands in the armpit or symptoms suggestive of distant organ involvement (bone pain, breathlessness, headache, enlarged liver etc.) need additional tests like PET-CT scan to rule out the spread of disease to other organs,”

Oncologists recommend Breast self-examination every month around five days after the periods are over starting from the age of 20. According to them, for postmenopausal women, it can be done on a certain day/date of every month. Annual breast examination by a trained doctor after the age of 20 is also strongly recommended. Finally, regular mammogram after the age of 40-45 is also recommended for early detection of Breast Cancers and timely treatment.

“People need to be aware of advanced treatment and facilities available in the country now. For example, our hospital has best-in-class treatment and care for breast cancer patients. It is very disappointing for us that a large number of patients come to us at advanced stages. Early Cancer or Stages I &II are usually treated by surgeries first. Locally advanced which is stage III requires chemotherapy first followed by surgery and radiation. Hormone and other targeted therapy are needed in the select group of patients who have certain markers present on their tumours. Stage IV (Distant organ spread) is treated either with chemotherapy or hormone therapy or both,” explained added Dr. Ronak Vyas, Surgical Oncologist at Narayana Multi Speciality Hospital, Ahmedabad.

With the emergence of advanced surgeries including oncoplastic breast surgery, oncologists/surgeons are now able to offer breast conservation to most patients with a good cosmetic outcome that boosts confidence and creates a positive impact on the psychological state of the patient.  According to the expert, newer techniques like Sentinel lymph node biopsy and Lymphovenous anastomosis help in reducing the lymphedema rates to less than 5 percent. Chemotherapy usually consists of 6-8 cycles administered in daycare at an interval of 15-21 days.

“Hormonal therapy for breast cancer treatment is continued for 5-10 years in the form of tablet and sometime in the form of injections also. For those patients who are having HER 2 Neu positive breast cancer, they require targeted therapy also which is typically given for a year. Chemotherapy may have side effects like hair loss, nausea, vomiting, and weakness, and most of these can be well taken care of by modern medicines.  Advanced imaging technology and radiation therapy technique in breast cancers result in an improvement in dose homogeneity, conformity and a decrease in radiation dose to organs at risk compared with older techniques.,” concludes Dr. JB Sharma, Sr. Consultant, Medical Oncology at Action Cancer Hospital, Delhi.

The experts recommend regular follow-up checks to monitor side effects. However, they underpinned that to leverage the benefits of breakthroughs, it is very critical to create awareness among girls and women.

The efficient management of cancer also requires supportive care such as psychological discomfort, the need for health information, and care planning. The speciality hospitals are paying good attention to supportive care. Effective treatments enhance the efficient delivery of care and support outcomes including pain and symptom management, quality of life, and mental health. The focus remains on the entire care pathway, from the initial suspicion of cancer through treatment, follow-up care after treatment, survivorship, and palliative care.