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By Dr. Devavrat Arya in Cancer Care / Oncology
Oct 25 , 2021 | 2 min read
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Breast cancer is one of the most common cancers in India, infact with approximately 1.5 lakh new cases diagnosed every year, it’s the most common cancer in women in the country. More importantly, numbers of breast cancers are increasing, particularly in the cities. This can be attributed to worsening lifestyle , with increase in rates of obesity, low exercise, late child birth, less breast feeding and increasing alcohol consumption amongst women.
While a large number of women are still diagnosed in advanced stages, with increasing awareness and the usage of screening mammography, many women now are able to detect cancers early
In early stages, with surgery, radiation, chemotherapy and targeted therapy, most patients are getting cured. The focus is increasingly towards smaller surgeries conserving the breast, lesser chemotherapy wherever safe and shorter radiation therapy protocols.
The real challenge is treatment of patients on advanced stages. So what’s new in the treatment of advanced breast cancer ?
There are certain breast cancers that express Estrogen and Progesterone receptors, the so called hormone receptor positive breast cancer. These are usually treated with oral hormonal therapy. The major advance has been the discovery of many new oral targeted therapies that not only enhance the effectiveness of hormonal therapy but also improve survival. This is ensuring that most these women live well for many years.
For those patients expressing Her 2, which is a receptor detected in tumour cells of approximately 25 percent women with advanced breast cancer, targeted therapies when added to chemotherapy or hormonal therapy have led to an improvement in survival. In the past 5 years, there have been atleast 5 new drugs that have improved effectiveness of treatment without adding much to side effects.
Triple negative cancers are the one that are truly difficult to control. The traditional treatment is usually chemotherapy alone. However, in the past two years, in select cases, Immunotherapy have added benefit. Immunotherapy is drugs that re activate our immune system. The immune system then kills the cancer. In triple negative breast cancers, select patients benefit with immunotherapy .Infact building on success in advanced stages, immunotherapy has shown benefit when combined with chemotherapy even in locally advanced triple negative breast cancers.
About 5 - 10 percent women get their breast cancers due to inheriting a defective gene from their parents called BRCA1/2. For those women who harbour these genes, in advanced stages targeted drugs called PARP inhibitors are now an effective treatment option. Infact even in earlier stages, usage of PARP inhibitors for those women with Defects in BRCA1/2 can improve cure rates.
All in all, breast cancer treatment is advancing at a rapid pace. For early stages, treatment is moving towards smaller surgeries, less chemotherapy and less radiation while maintaining the high cure rates. For advanced stage patient, newer chemotherapy, targeted therapies and immunotherapy options are ensuring not only that the patients live long, but also live with an excellent quality of life
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