Dr Bhavisha Ghugare, Consultant – Surgical Oncology, Kokilaben Dhirubhai Ambani Hospital emphasises that the advancement of breast cancer diagnosis and therapy has been significantly aided by technology. Chemotherapy and hormone therapy have been used now for many years. These are now bolstered by the discovery of novel treatment methodologies and new drugs.
Breast cancer is today the commonest malignancy globally and surpassed lung cancer in 2020[1]. Every 14 seconds, a woman somewhere in the world is diagnosed with breast cancer and every 50 seconds, a woman loses her life to this dreaded disease. In India, breast cancer was the fourth most common cancer during the 1990s, but is today the most common. The latest Globocan data[2] for India indicate that breast cancer accounts for 13.5 per cent of all new cancer cases and 26.3 per cent of all new cases in women. It was also responsible for 10.6 per cent of all deaths from cancer.
The ability of breast cancer to metastasise and the high risk of recurrence after treatment contribute to breast cancer being the leading cause of death in women. These deaths are disproportionately more in low- and middle-income countries. In India, we see younger patients with more aggressive cancers and diagnoses at a late stage of the disease leading to poorer outcomes.
At the same time, high-income and developed countries have been showing a steady decline in deaths from breast cancer with a 40 per cent reduction in deaths since the 1980s.[3] The reasons for this include better coverage of essential health services with easy access to cancer treatment centres and advances in medical science. This leads to diagnosis at an early stage and better treatment outcomes with a reduction in mortality.
Modern medical research is also throwing light on some of the key factors that lead to breast cancer and result in its recurrence. Today, we can recognise the different biological and genetic makeup behind malignancy. Research involving the role of gene mutations is giving new insights into predicting the risk of breast cancer developing in an individual.
Research has also led to new therapies and drugs that have shown good efficacy against recurrent breast cancer. Scientific advances are today occurring at a faster pace with many new effective treatments also available now in India. These are helping patients with breast cancer live longer with a better quality of life.
Breast cancer screening results in early detection and improves survival. Screening (mammography) continues to be relevant and very important even in the era of genetic screening and precision medicine. Novel developments today allow liquid biopsies that recognize circulating tumor cells (CTCs). These provide a less-expensive and non-invasive method of predicting disease severity and potential for survival of breast cancer patients.
It is now possible to recognise various types of breast cancer at a molecular level and offer patients specific treatment that is personalised to their cancer and tailored to their type of disease. About 5 per cent to 10 per cent of women diagnosed with breast cancer have mutations of genes BRCA1 and BRCA2, which are genes and proteins that contribute towards the development of breast cancer. In addition, tumor profiling using artificial intelligence and machine learning allows us to predict how a particular breast cancer will respond to a particular drug leading us to choose the most effective one.
The advancement of breast cancer diagnosis and therapy has been significantly aided by technology. Chemotherapy and hormone therapy have been used now for many years. These are now bolstered by the discovery of novel treatment methodologies and new drugs. The new drugs include Cyclin-Dependent Kinase inhibitors, Poly-ADP Ribose Polymerase inhibitors, antibody-drug conjugates and immunotherapy.
Artificial intelligence (AI) and machine learning (ML) have been used to develop tools and algorithms that increase the efficacy of tailored precision medicine treatment for cancer patients. Nanotechnology is also bringing in accuracy in the use of precision medicine treatment for cancer. Many of these treatments are game-changers for breast cancer patients.
Radiotherapy can be delivered in a more precise manner, over a shorter duration now. Coming to surgeries, the advent and adoption of robotic surgery means that surgeries are less disfiguring now and the removal of the tumor is even more precise than with conventional surgery. Breast conservation and reconstruction are viable and effective options.
Treatment of breast cancer today needs a multi-disciplinary approach. Healthcare institutions with full-time doctors and specialists on board are more beneficial to a patient as against a hospital with visiting consultants. This is because institutions invest in the latest technology and ensure their doctors are trained and skilled in the latest protocols. The doctors working full-time also gain substantial experience in the use of cutting-edge technology for breast cancer treatment.
In just one decade from 2010 to 2020, there were 30 FDA approvals of new treatments for breast cancer. All these are encouraging developments for breast cancer patients and doctors involved in their treatment. The field is ever-evolving, adding not only years to the lives of breast cancer patients but also life to their remaining years. We are optimistic about a better tomorrow for patients suffering from breast cancer. We must choose hope as once you choose hope, anything is possible!
References:
[1] https://www.bcrf.org/breast-cancer-statistics-and-resources/
[2] https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf
[3] https://www.who.int/initiatives/global-breast-cancer-initiative/breast-cancer-inequities
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