Are you amongst the millions who associate breast cancer with fatality; a disease that is almost impossible to cure and one that definitely involves chemotherapy? Most people believe that cancer treatments and medicines have little benefit. However, a look into new findings and new discoveries in the field of oncology is enough to change this common perception about breast cancer.
For years, doctors and oncologists have chosen chemotherapy and radiation as a post-surgical breast cancer treatment. The knowledge, willingness, and proactive approach of the oncologists’ and his/her involvement with the patient’s treatment play a vital role in the treatment of breast cancer.
The oncologist and the patient
The oncologist is not only responsible for the diagnosis, but is also responsible for providing clarity and knowledge to the patient about the particular individual patient’s cancer case. Most importantly, the oncologist is responsible for deciding and charting out the best treatment course for the patient. Discussions surrounding prognosis often require oncologists to be sensitive, at the same time honest, and encouraging.
The treatment to a particular breast cancer patient and the response to treatment is unique to each patient and the oncologist must share relevant information with the patient. Apart from this, the oncologists are responsible for the follow-up post-treatment to assess the effectiveness of the treatment.
Oncologists have to consider many factors when determining a patient’s treatment and one thing that is often difficult to decide is whether a patient should be given chemotherapy or not. Several factors are considered:
- The size of the breast cancer tumor
- The stage of breast cancer
- Whether the cancer is only in the breast or has spread to other parts of the body
- The hormone-receptor status of the cancer
- Whether the cancer is triple-negative (estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative)
- The rate of cell growth
- If the cancer is likely to come back (recurrence)
- Factors such as the age, menopausal status, and general health of the patient.
According to an assessment by WHO, cancer cases in India will multiply over five times by 2025
Oncologists are aware that patients and their families might not have adequate knowledge about breast cancer and hence, are responsible for answering various queries of the patients.
Most patients associate cancer with chemotherapy and one of their first set of questions include queries about chemotherapy: How many sessions of chemotherapy will be required, what are the side-effects, what are the costs involved, will chemotherapy benefit, and what exactly happens during chemotherapy? Among other common questions are: will cancer come back after the surgery? How aggressive is the cancer and how fast is it spreading?
A large number of patients and their families aren’t aware of the alternative treatments for breast cancer that are available in the country today. Hence, it is the oncologist’s responsibility to introduce the patients to new treatment options so that the patients consider all the available options.
Oncologists and cancer clinics have to be up-to-date with the latest research and findings in the field of medical research to be able to provide the best treatment to their patients.
Breast cancer trends and cure
In India, breast cancer cases are on the rise, whereas there has always been a shortage of oncologists’ and specialists’. Moreover, quality treatments and well-equipped hospitals are sparse and scattered, concentrated mostly in urban areas. There has been an increase in the number of new discoveries, alternative cancer care options, and innovative personalized treatment options for breast cancer patients in India.
In the last 5 decades, breast cancer treatment has become the model for the development and success of tailored medical treatment.
Therapeutic approaches for breast cancer have changed over the past few decades, and the use of systemic therapy for early and advanced disease tailored to the individual patient holds the promise of delivering treatment to those in need and who could benefit the most. While we’re nowhere near where we should be or could be—in either preventing or treating cancer—science has led to evident progress in treating breast cancers of different kinds.
Advances in hormone therapy for hormone-receptor-positive cancer
Some breast cancers are driven by natural hormones estrogen and progesterone. These are referred to as hormone receptor-positive if they are estrogen receptor-positive (ER positive) and/or progesterone receptor positive (PR positive). Hormone therapy for breast cancer is only used to treat cancers that are ER or PR positive.
Despite conventional hormone therapy, approximately 20–30% of patients with hormone receptor-positive breast cancer suffer recurrences and the development of metastatic disease as they experience a biochemical mechanism of resistance. Considerable progress has been made in this area, and newer therapeutic targets have been developed against a number of hormonal resistance mechanisms.
Are all patients with early breast cancer benefiting from chemotherapy? A number of experts and oncologists asked this question. Some delved deeper into it. With this question in mind, global investigators motivated by the development of new prognostic and predictive tests such as OncoStem Diagnostic’s CanAssist Breast have been focusing on how to personalize therapies so that only the necessary treatment is given to patients and overtreatment is avoided. OncoStem Diagnostic’s study resulted in the creation of a simple AI-based test that predicts breast cancer recurrence risk over five years.
Clinical research is currently evaluating new therapeutic approaches and is identifying specific biological subsets that could determine a patient’s ability to respond to particular treatment.
Scientific, machine-learning precision – CanAssist Breast
Artificial intelligence and machine learning is an emerging approach to breast cancer. CanAssist Breast is the first such test developed in India, specifically for Indian patients. It determines the tumor’s fingerprint and assesses its aggressiveness. Assessing the tumor biology in detail, the test considers key biomarkers. Based on this combined analysis performed by proteomics-based technology, the information is then assessed by a statistical algorithm that provides a score – whether the patient is at low or high risk for breast cancer recurrence.
The importance of medical research
The advent of new drugs targeting specific actionable targets has led to considerable progress in the treatment of breast cancer over the past few years. Yet, some challenges remain; such as resistance to systemic therapy, the high cost of treatments, and limited availability in many parts of the country.
Experts continue to find ways to improve the available technology to provide proper guidance for those living with breast cancer, and for those at high risk of developing it, and to develop new, more effective therapies to improve the treatment outcomes substantially.
The author of this blog, Dr.JayantiThumsi, has been a practicing breast oncologist for 16 years, has performed 3500 breast surgeries and 2500 other surgeries. She is an expert in Breast conservation and Breast Reconstruction surgeries. With a keen interest in spreading breast cancer awareness among women, she has conducted 258 awareness programs and has educated 158000 women. She is also the founder trustee of the CREST Foundation working to decrease the burden of breast cancer. Her book, Lump to Laughter, highlights the emotional journey of women going through breast cancer treatment.