Prognostic tests can help avoid chemo in 60% early breast cancer cases; but over 50% patients diagnosed in late stages

Obesity major contributor to rising disease burden; 1 in 25 women face lifetime risk of breast cancer in India, early detection can improve survival rate to 80-90 per cent

Early disease detection and use of new age prognostic tests to personalise treatment plans can help improve breast cancer survival rates to up to 90 per cent. Unfortunately, unlike in the US where over 70 per cent patients are diagnosed in early stages, in India over 50 per cent of patients are still diagnosed in advanced disease stages, resulting in a large burden of preventable deaths.

As October is observed as Breast Cancer Awareness Month, oncologists are underlining the need to increase early stage diagnosis and make prognostic tests which help in identifying patients avoid toxic modalities of treatments, such as CanAssist Breast available to a larger number of patients.

Padma Shri Dr Ramakant Deshpande, onco surgeon and Chairman,  Asian Cancer Institute expresses concern over rising disease incidence in relatively younger women and identifies increasing prevalence of obesity, consumption of processed foods, stress, lack of physical exercise and delayed pregnancies as contributing factors to the rising disease graph. He says that one in 25 women in India have a lifetime risk of developing breast cancer with women in urban areas facing a higher risk.

“Advanced treatment modalities, ability to personalise treatment and use of new age prognostic tests today give us the ability to significantly prolong lives and save 80-90 per cent of breast cancer patients. Earlier most patients, even in relatively early stages were administered chemotherapy as an adjunct to surgery with the hope that it will improve survival, as there was no definite way of identifying tumours with lower aggressive potential where such toxic treatment could be avoided. Now, in early stage diseases, up to 60 per cent of patients can be spared chemotherapy and many can avoid total mastectomy by undergoing prognostic tests such as CanAssist Breast in the early disease stage. Unfortunately, over 50 per cent of breast cancers in India are diagnosed in stages 3 and 4, resulting in a large number of preventable deaths and low survival rates,” said Dr Ramakant Deshpande.

Notably, breast cancer survival rates have improved significantly in western countries where preventive screenings and awareness ensure that a majority of cases are identified in the early stage of disease. In the US, it is estimated that up to 90 per cent of women survive five years of diagnosis and 84 per cent manage to survive 10 years. In India the survival rates remain much lower.

Patients diagnosed with stage 1 or 2 breast cancers can undergo breast conserving surgery (BCS) which enables them to save their breasts. The possibility of avoiding aggressive treatment and chemotherapy is another major benefit of early detection.

“Early stage breast cancer patients are recommended the use of prognostic tests such as CanAssist Breast to direct the use of chemotherapy. While chemotherapy is essential in many cases, it also has its side effects including psychological effects, possible hair loss, cosmetic changes- though temporary and reversible and a small possibility of bone marrow changes. Prognostic tests help identify the group of breast cancer patients which has a high risk of metastatic disease or relapse and we can actually target only that population for chemotherapy, sparing practically 60-70 per cent of patients from unnecessary chemotherapy. It not only improves quality of life and survival but also reduces cost of treatment for many,” added Dr Deshpande.

With COVID-19 further delaying disease presentation in a large number of women and interrupting treatment in others, Dr Deshpande is concerned that the pandemic may result in a higher breast cancer deaths over the next few years.

“The COVID-19 pandemic has further hampered timely hospital approach of patients, disease detection and treatment. Over the past six months, delayed diagnosis and thereby change in stage at first presentation itself has emerged as a major concern and since patients are presenting together now after a gap of nearly six months, disease presentation incidence at hospitals has almost doubled because of delays due to COVID. For patients living in rural areas it has been particularly difficult to be able to reach an oncologist on time. It is important to educate women to not delay reporting their symptoms because of the fear of pandemic because even a month’s delay in starting treatment can make the difference of life and death when it comes to breast cancer. There is no bar in undertaking diagnostic or therapeutic procedures including surgery, chemotherapy or radiotherapy even during Covid time’s with certain precautions,” added Dr Deshpande.

Increased awareness, regular screening after 40 years of age, early detection, adoption of healthy and active lifestyles can help control incidence of disease and help with early presentation and higher cures.

“Obesity, consumption of unhealthy processed foods, delayed age of child birth, lack of physical activity and high stress contributes towards increase in breast cancer incidence. Obesity per se is responsible for increasing the incidence by almost 70 per cent. Healthy living, good sleep, exercise, healthy diet and weight control can reduce risk of disease,” he added.