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Written by Editorial Team |Updated : October 31, 2023 6:01 PM IST
Breast cancer has overtaken lung cancer to become the most common cancer in the world. The burden of breast diseases is rising across the globe, and it has become the leading cause of cancer related deaths. Men can also get breast cancer although it is rare (1% incidence). Breast cancer is a multifactorial disease and is influenced by a combination of genetic and environmental factors. Age, family history, genetic mutations, hormonal factors, and lifestyle choices such as smoking, alcohol consumption, inactivity and ob sity are among the risk factors.
Some common presentations of breast cancer are:
Early detection and diagnosis is pivotal in breast cancer survival rates. Screening Mammograms with addition of tomosynthesis (3D mammogram) can detect smaller or hidden tumours in women who are asymptomatic.
Advances in research have established standard of care in breast cancer surgical management which is patient centric, higher emphasis on cosmesis without compromising oncologic safety and improved quality of life.
Unless contraindicated, surgery of choice is breast conserving surgery (BCS). Research has proven that in terms of survival and recurrences, Modified Radical Mastectomy is equivalent to BCS with adjuvant radiation. Oncoplastic surgery allows wide excision for BCS without compromising the natural shape of the breast. It is based on integration of plastic surgery techniques for immediate breast reshaping after wide excision of breast cancer.
Previously, all axillary lymph nodes used to be removed routinely during breast cancer surgery to test for metastasis. This causes chronic pain, numbness and lymphoedema in about 1 in 5 patients. These side effects can be reduced or eliminated by targeted axillary lymph node dissection or sentinel lymph node biopsy. LYMPHA technique (lymphatic microsurgery preventive healing approach) can also be used wherein at the time of surgery arm lymphatics are anastamosed to a tributary of axillary vein , thereby reducing arm lymphoedema rate from 15% to 2%.
A greater understanding of the immune system, genetics and cancer pathology has opened the doors to an ever-increasing range of new cancer treatments and diagnostic tools.
Genomic analyses, have provided more insights into the molecular diversity of breast cancer and eventually help identify more breast cancer subtypes. This knowledge, in turn, has led to the development of therapies that target the genetic alterations that drive those cancer subtypes.
HER2-targeted therapies, such as Herceptin and Pertuzumab, have significantly improved outcomes for HER2-positive breast cancer patients. T-DM1, an antibody-drug combination, has been approved for use in the treatment of HER2+ breast cancers. Antibody-drug combinations deliver chemotherapy directly to cancer cells by attaching to their HER2+ receptors.
Studies show that Hormone receptor-positive metastatic breast cancer patients do even better when hormone therapy is combined with CDK4/6 inhibitors (Abemaciclib, Palbociclib), which prevent cancer cells from dividing.
This is a treatment option for some types of breast cancer. It uses medications to stimulate the immune system to destroy cancer cells. Pembrolizumab is approved by the FDA for some patients with metastatic and early-stage triple-negative breast cancer. It's an immune checkpoint inhibitor, the most common type of immunotherapy. Immunotherapy is also used in combination with other treatments, such as chemotherapy, to target cancer cells.
These are used in treating breast cancers associated with BRCA mutations. These inhibitors target specific DNA repair pathways, making cancer cells more susceptible to damage.
Advances in Radiation therapy has achieved precision in accurate planning, accurate positioning and accurate treatment minimizing exposure to normal tissue and organs. Intensity modulated radiation therapy and proton therapy minimize exposure to healthy tissue. Hypofractionated Radiation and accelerated partial breast irradiation have decreased the treatment time.
There have been many advancements in breast cancer research and treatment enabling a tailormade treatment plan for patients. Improved understanding of the biologic heterogeneity of BC has allowed the development of more effective and individualized approach to treatment.
Complementary and integrative therapies (acupuncture, prayers, massages, yoga) are used in addition to standard medical treatments. They may relieve side effects and improve quality of life. Recent studies prove that Yoga combined with treatment of breast cancer helped reduce fatigue, pain and improved arm movements and emotional function. Support groups and other activities which foster connection with others are essential support system for patients.
In breast cancer treatment, early detection is the best protection , hence screening should be promoted.
(This article is authored by Dr Shubha Sinha, Consultant, Breast & Oncoplastic Surgeon, Apollo Cancer Center, Ahmedabad)
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