Cancer, the silent killer, affects many across the world, irrespective of one’s social or economic status. Getting diagnosed with the disease instils enormous fear in the patient and their family even today. A few decades ago, the diagnosis itself was considered the end of hope because of the mental impact it had on the patient and their family. In addition to that, the anxiety of the financial burden rattled patients and their caregivers.
Speaking about breast cancer, Dr Sravan Kumar Bodepudi, MD, DM Consultant Medical & Hemato-Oncologist, Manipal Hospitals, Vijayawada, says, “Breast cancer is on the rise, both in rural and urban India. The latest report of breast cancer statistics recorded 1,62,468 new registered cases and 87,090 reported deaths. Cancer survival becomes more difficult in higher stages of its growth, and almost 50 per cent of Indian women suffer from stage three and four of breast cancer. Late detection of the disease is a huge concern for clinicians when it comes to treatment of the disease.” One of the primary causes for the higher number of breast cancer mortalities in both rural and urban India is late detection, usually due to lack of awareness, having a lackadaisical attitude, socio-economic conditions, illiteracy, and limited access to healthcare.
Dr Bodepudi is of the opinion that with a paradigm shift in diagnostic/prognostic/precision medicine in cancer, many cancer patients have been able to lead a disease-free life. “Even in India, the last five to seven years have seen significant advances in treatment options, which have led to favourable outcomes for patients. Precision medicine, somatic gene profiling, genetic testing, hereditary testing have led to early detection, which is crucial for breast cancer prevention and treatment.”
Cancer treatment has evolved from a blanket approach to a more tailored one that is in line with the patient’s condition, requirement and financial standing. Dr Bodepudi shares how these new advances can benefit cancer patients.
Increase In Survival Rate And Prevention Of Breast Cancer
Over the last few years, breast cancer testing has categorically been divided into somatic genetic testing and hereditary genetic testing. Somatic genetic testing is done on patients who have been diagnosed with the disease. This enables clinicians to offer personalised medicine depending on factors like mutations of genes. “On the other hand, hereditary genetic testing has opened up preventive care for breast cancer. This, combined with bioinformatics, by utilising familial history, has enabled healthy individuals to understand the risk of breast and ovarian cancer by simply testing Brca1 and Brca2 genes. This test predicts the age and the risk of cancer occurrence, profoundly impacting the future cancer care of a patient,” explains Dr Bodepudi.
Once one is aware of the risk of occurrence, the individual might have to undergo mastectomy or oophorectomy, thus reducing her chances of getting breast or ovarian cancer in her lifetime. Dr Bodepudi says, “In doing so, they zero down the risk of getting this cancer in comparison to other healthy individuals. With hereditary genetic testing, even men with strong familial history are now more aware of their chances of being diagnosed with breast cancer.”
An Option For Early Stage Patients To Avoid Chemotherapy
Many cancer patients are reluctant to undergo chemotherapy, mainly due to the toxic side effects associated with it, such as hair fall. The stigma attached to it has a severe psychological impact on the patient too.
Chemotherapy is generally given either pre- or post-surgery to decrease the disease burden or to remove the residual cancer cells in their body. Dr Bodepudi says, “Each patient requires a different approach; a one-size-fits-all formula is no longer recommended. Many women who are in the early stages, can safely avoid chemotherapy through prognostic tests that accurately predict the risk of cancer recurrence. These prognostic tests enable patients and the clinicians to take a consented decision based on the test result.”
Note that the test is performed post-surgery on the tumour block of breast cancer patients with ER/PR positive and Her2/neu negative. The patient is then given a risk score; if the patient has a low score, they can be spared chemotherapy after discussing with their clinicians and continue with hormonal therapy. If the patient earns a higher risk score, it enables clinicians to convince patients about the need for chemotherapy.
Personalised diagnosis, treatment and prognosis has helped change the mental, physical, and financial dynamics of breast cancer treatment in India. It has helped change perceptions around cancer treatment too. Thanks to the advances in research, patients and caregivers have started living with hope, which in turn is putting a wider smile on the faces of the medical fraternity as they see their patients living a quality life.
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