In 1894, US surgeon William Halsted theorised that breast cancer spreads from the primary tumour to the rest of the body through the surrounding tissue and lymph nodes. His insight led to the development of Halsted radical mastectomy as a treatment approach.
In this, the surgeon removed the full breast, the surrounding lymph nodes and chest muscles. Although this decreased breast cancer mortality rates and resulted in fewer cancer recurrences, it caused significant side effects and cosmetic disfigurement that diminished the quality of life for thousands of women.
Today, the main factors that influence breast cancer treatment options are: the stage of the tumour; tumour subtype – including hormone receptor status (ER, PR) and HER2 status; genomic markers; patient’s age, general health status and lifest-yle; the patient’s menopausal status; and the presence of kno-wn mutations in inherited breast cancer genes – BRCA1 or BRCA2.
Research has shown that women who have mutations in their BRCA1 and BRCA2 genes have a 50-85% increased risk of developing breast and ovarian cancer. Early identification of this important genetic risk factor for cancer enables women with these mutations to undergo more frequent screening and, in some cases, undergo preventive surgical removal of the breasts, ovaries or both. How the above factors determine disease prognosis and response to treatment is being studied continuously, giving us interesting insights.
Surgical resection remains the cornerstone of breast cancer therapy and has been found to be more effective in patients with early-stage breast cancer. Other treatment options at all stages include radiation therapy, chemotherapy, targeted therapy and hormonal therapy.
Radiation therapy uses high-energy x-rays or other particles to kill cancer cells. Chemotherapy involves the use of drugs which destroy cancer cells by interfering with their ability to grow and divide.
Targeted therapy targets specific genes or proteins of cancer cells or the tissue environment that contributes to cancer grow-th and survival. Targeted therapy is available for HER2+, ER/ PR+ breast cancer patients and is being developed for patients whose cancer is caused by a mutation in one of the two most common breast cancer genes (BRCA1 and BRCA2). Unlike chemotherapy, these treatments are very focused as they limit the damage caused to healthy cells.
As certain types of tumours use hormones to fuel their grow-th, hormone therapy – also call-ed endocrine therapy – works by either blocking the body’s ability to produce hormones or by interfering with hormone action. It is an effective treatment for tumours that test positive for either oestrogen or progesterone receptors (ER-positive or PR-positive), in both early-stage and metastatic breast cancer.
Neoadjuvant therapy
These options, alone or in co-mbination, allow us to treat bre-ast cancer more effectively and with a greater degree of confidence. A relatively recent breakthrough in the concept of treating breast cancer is the use of chemotherapy and/or targeted therapy to shrink tumours befo-re they are surgically removed.
This approach, known as neoadjuvant therapy, has enabled more than two-thirds of women with large breast tumours to undergo breast-conserving surgery (lumpectomy), instead of what would have otherwise been surgical removal of the entire breast (mastectomy).
It is important to talk to your oncologist to figure out the best treatment option for you. He or she will discuss the benefits and possible side effects of each treatment option, which will help you to make a decision that is most suited to your situation. It is also important to ask questions and voice any concerns that you may have.
Breast cancer is now the most common cancer in India. We are also witnessing more and more young people being diagnosed with the disease, with many of them in their 30s and 40s. When we compare India’s breast cancer statistics with that of the US and China, the numbers are of great concern.
In 2012, 1,44,937 women were newly detected with breast cancer in the country, out of which 70,218 women lost their lives to the disease. This represents a 1/2 ratio of breast cancer cases diagnosed to lives lost in India. In the US, this ratio is 1/6 and in China, 1/4.
Though the numbers and statistics associated with the disease are causes for concern and warrant urgent attention, the good news is that treatment options for breast cancer are increasing both in number and efficiency, giving patients more options today than ever before. Such advances will enable wo-men to better fight the disease, reduce pain and other associated side-effects and ensure a qui-cker return to their normal lives.
(The writer is Senior Consultant Medical Oncologist, HCG Hospitals, Bengaluru)
Published 15 November 2016, 17:43 IST