Gene expression profiling advocated for cases of early tumours

"Gene expression profiling is being encouraged in early tumours to help doctors find out the possibility of recurrence of tumour in a patient subsequently and thereby suggest the line of treatment", said Dr Niti Narang of HCG hospital, Head of Breast Oncology and Genetic Counselling.

October is being observed world over as Breast Cancer Awareness month. A gene expression profiling test analyzes patterns of a number of different genes within the cancer cells to help predict how likely it is for an early-stage breast cancer to recur after initial treatment.

It helps people who don't need additional treatment (adjuvant therapy) to avoid the side effects of unnecessary treatment and for those who may benefit from adjuvant therapy to receive it. Such tests are used to try and determine right treatment for the right person with early-stage breast cancer.

However, the main hurdle in terms of gene profiling is it is not very easily available in India and not many patients can access such specialised services, she said.

Another line advocated is to have a biological marker test done. This is routinely followed and also easily available.

A biological marker helps categorize patients and help understand whether biological therapies can be given.

"Individualised treatment in breast cancer also make a difference because each patient needs different combinations of treatment, depending upon the size of the tumour, the expression of markers and in tems of gene profile", she said.

"Two women might need two different kinds of treatment as the size of their tumour and the stage of spread of cancer may vary. Even if the size of the tumour is the same, much would also depend on other factors, like genes, hereditary factors and biological markers", she said.

A woman with a one cm tumour but who does not fall in the high risk group in terms of gene profiling or biological markers and other factors would be put on different treatment, while another with a similar sized tumour,but in the high risk group would be given more intense kind of treatment, she said.

All efforts being taken to spread awareness on cancer still fall short compared to the awareness level in the West, she says."In the West,women are beyond the self-examination stage. Mammography test for those over 40 is mandatory for insurance consideration, are taken at periodical intervals and results compared minutely to check for any growth".

"In India, women continue to rely on self examination to detect any lumps or growth in their breast. However, for a woman to be able to detect a lump or growth, the tumour will have to be slightly enlarged, which is late compared to mammography test which detects even less than one cm leisons," Dr Niti said.

The key to effective breast cancer treatment was catching the tumours small at an early stage, she said.

Akin to the West, there is a need to encourage women, especially after they touch 40 and have a family history,to go in for periodic mammography test and make it a regular policy.

In the West, the medical scene is very advanced, making mammography test mandatory to seek insurance, an initiative that also needed to promoted largely in India, she said.
Dr Niti however,agreed that much of the initial reluctance of going in for breast cancer test is slowly waning,especially in urban cities, where women are more aware. In rural areas too, some sort of awareness has crept in.

Almost 95 per cent of women who came and were detected with tumours returned to have it treated, Dr Niti said, adding that defaulting on treatment was not a common occurence.

But Indian women continued to rely on mastectomy (removal of breast) and radiation for treating breast cancer. Many did not choose the option of breast conservation surgery followed by radiation. "The results in both are almost equal",she said.

The reasons for patients going in for breast removal could be attributed to low awareness level relating to conservation of breast treatment and also the fear that the tumour might crop up again on the effected breast, she said.

However, patients failed to understand cancer was not a localised disease, but a systemic disease and needed to be treated in that way. "There is a need to have a change in mindset on the issue". Women need to be discouraged from going in for removal if possible and go in for conservation.

Another major ignorance in the area of breast cancer was that even males could have it. The chances of a male having breast cancer was one in 100 patients (with 99 being women).

However, due to ignorance, many men ignore the growth or lump in their breast. Many mistake it for some type of hardness or a kind of ulcer and often walk in at a late stage.
There is a need to have awareness about male breast cancer to help early detection, she said.

It was also increasingly noticed that younger women or those in their pre-menopausal stage were reporting tumours.

She said there was much research being conducted in the field of oncology, which offers hope for cancer patients in future.