Breast Cancer - A Basic Understanding (Focus: India)
Cancer awareness is a continuous exercise that requires a multi-dimensional approach and proactive involvement of every stakeholder. Oncofocus, being a management consulting and research firm, will be publishing every month a short interview with leading Oncologists across the APAC region on a particular Cancer type. The main objective of these interviews is to learn the "What, Why, How" of the present state of cancer management directly from the treaters.
October being the Breast Cancer Awareness Month, we have dedicated two posts in our Cancer Interview series towards breast cancer awareness. In the fourth post of our Oncology interview series, our analyst Shimi Manayath Panakkal connected with Dr. Aparna S, Consultant Medical Oncologist.
Dr Aparna S MD, DM (Medical Oncology), MRCP(UK) Consultant Medical Oncologist, Sahyadri Narayana Multi-specialty Hospital, Shimoga, Karnataka, India
We understand that most cancers are manageable if they are identified at an early stage, so for someone to get an early diagnosis, what are the signs and symptoms we should look for? Dr. Aparna: Early stage breast cancers are curable. First and second stage cancers are termed as early-stage cancer and are usually curable. The third and fourth stage are termed as secondary stage cancers. Though they are not curable, they can be controlled with medications. Today, there is not only chemotherapy but a wide variety of options like hormone therapy, targeted therapy and immunotherapy to tackle such advanced stage disease. In the first stage of breast cancer, the earliest symptom is a lump in the breast, which might be painless. Generally, women tend to neglect that and do not consult a doctor. But as the disease progresses, the lump will start growing and spreading to other body parts body like armpits. This is when the patients will seek medical care. At later stages, the skin around the breast becomes red, and the nodes start appearing outside. The area becomes ulcerated and oozes blood and pus, which is the symptom of last stage breast cancer.
Cancer does not occur in one day; it takes decades to grow and exhibit the symptoms. By conducting mammography, we can pick up breast cancer at an early stage, even before signs and symptoms present.
What are your suggestions to increase early diagnosis in breast cancer? Dr. Aparna: One thing I would say is that women should go for screening. Cancer does not occur in one day; it takes decades to grow and exhibit the symptoms. By conducting mammography, we can pick up breast cancer at an early stage, even before signs and symptoms present. So, early breast cancer can be detected with regular screening and can be cured with proper treatment. Who should get mammography?
Dr. Aparna:Any women who are above the age of 40 should get it done. One should understand that cancer is a disease of aging. Self-examination of the breast should be done once in a month to check for any lumps in the breast. Being familiar with how one’s own breasts look and feel, can help to notice symptoms such as lumps, pain, or changes in size, etc.
Who are at risk of developing breast cancer?
Dr. Aparna: As I mentioned earlier, women above the age of 40 are at risk, as cancer is a disease of aging. Women with close relatives who are diagnosed with breast cancer have a higher risk of developing the disease. If one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, then the risk factor is doubled. Therefore, anyone who has a family history of breast or ovarian cancer should get mammography done by the age of 25. What are the major types of Breast Cancer?
Dr. Aparna: There are three major types.
One is hormone receptor-positive. For hormone receptor-positive breast cancer, we give something called hormone therapy. They are not very aggressive cancer and will respond to treatment.
The second type is HER2+ve; basically, cancers expressing HER2 protein on the cell surface. This HER2+ve breast cancer will respond only to targeted therapy.
The third one is called triple-negative breast cancer; they will not have any hormone receptors or HER2 receptors, and it’s a very aggressive type of cancer, and usually, they respond to chemotherapy
When detected in the early stages, it can be cured completely. The only thing required is patient compliance while taking their medication.
What is the prognosis? What are the common treatment options?
Dr. Aparna: Prognosis depends upon the stage of cancer.
When detected in the early stages, it can be cured completely. The only thing required is patient compliance while taking their medication. The treatment regimen is a full-fledged package and is a road to recovery, so irrespective of the treatment type -surgery, radiation, chemotherapy – the patients must follow the treatment instructions scrupulously to lead a normal healthy life.
If they have hormone receptor-positive cancer, they must take hormone tablets every day for 10 years post, which will be cured completely. In India, people stop the treatment halfway due to financial issues, resulting in the cancer recurrence.
In the third and fourth stage of cancer, we can only control the disease but cannot cure it completely. Today, even with Stage 4 breast cancer, patients are surviving up to 5 years.
Do you foresee any interesting trends in terms of breast cancer space?
Dr. Aparna: In terms of new developments, there are some drugs that are available in the market, especially for HER2+ve cancer, which is treated with targeted therapies. Targeted therapies work like a magic bullet, wherein the drug hits the cancer cell specifically without causing side-effects.
There are also immunotherapies, which artificially stimulate the immune system to treat cancer. This strategy improves patients’ immune systems and natural ability to fight cancer.