New Advances In Breast Cancer Treatment And Care: Impact On Indian Patients

Breast cancer treatment is highly effective when the disease is identified early. Here are some of the latest developments in breast cancer diagnosis and treatment.

Do you know which is the most commonly diagnosed cancer worldwide? It's breast cancer, not lung cancer. Data released by the International Agency for Research on Cancer (IARC) in December 2020 showed that breast cancer has replaced lung cancer as the most common form of cancer across the globe. According to the World Health Organization (WHO), globally 2.3 million women were diagnosed with breast cancer and as many as 685 000 women died from the disease in 2020. Delay in diagnosis and treatment is one of the reasons for high breast cancer mortality rates.

Take note, breast cancer is highly treatable when the disease is identified early. Moreover, new advances in breast cancer treatment have greatly improved patients' survival rates and their quality of life.

To know the latest developments in the breast cancer treatment, TheHealthSite connected with Dr Javvid Muzamil, Medical Oncologist Medicare Hospital, Srinagar. Below are excerpts from the exclusive interaction:

Q. What are the major changes in breast cancer diagnosis andtreatment the world has seen in the last decade?

In the last decade, a lot has changed in the diagnosis and management of all malignancies, and so is in breast cancer.

• Earlier we used to see this disease mostly in women above 50 years of age, now there is an increasing incidence in younger age groups and males as well. Its incidence has increased all over the world and region-wise as well. In our region, we are seeing this as the number one malignancy in females as of today.
• Diagnostics have also changed a lot. We are able to stage breast cancer perfectly as it is. PET CT has been added to the diagnostic armamentarium.
• One more molecular test CanAssist Breast from OncoStem Diagnostics has been available for the past 5 years for prognostication in patients to decide if there's benefit of chemotherapy in the patients. This test has been specifically developed on Indian Patients.
• In spite of the trend in younger females, better treatment facilities in treatment are available for the cure and to control disease progression.
• Genetics of breast cancer is being decoded in multiple projects, so far we are aware of BRCA, P53, Hormone positive, HER 2 neu positive, Triple negative, basal, mesenchymal types, and Androgen associated breast cancers.
• If cancer has recurred, we can now be certain whether it is a recurrence of a previous malignancy or a new 2nd primary due to the advancements in molecular signatures.

Q. Can you shed some light on advances in breast cancer management as well?

With the advent of molecular tests, clinicians can now have an idea as to how the disease will progress in an individual patient. There are many breast cancer prognostic tests available that help clinicians in treatment decision planning for hormone-positive early-stage breast cancer patients. These tests analyze specific biomarkers to understand if a patient will benefit from chemotherapy or not.

One such test is CanAssist Breast which has been specifically developed on Indian patient population and uses 5 patented biomarkers along with 3 clinical parameters to determine a patient's risk of recurrence of the disease. If the patient is categorized as low-risk, they will not benefit from chemotherapy and can skip the aggressive chemotherapy treatment. Only high-risk patients benefit from chemotherapy.

Another important advancement is the use of HER2-directed therapies. HER2 is a protein that promotes the growth of cancer cells has an important impact on breast cancer survival. Though not all breast cancers overexpress HER2, those that do (about one in five) can be effectively treated with drugs that target this protein. HER2-directed therapies have revolutionized the treatment of HER2-positive breast cancer. As these drugs can be used for both early- and late-stage HER2-positive breast cancer, they can benefit a wide range of patients and can help reduce recurrence risk in early-stage disease.

There are also many new imaging tests that help researchers to screen for breast cancer better. Earlier, doctors used mammograms or ultrasounds to screen for breast cancer. But now, many new types of tests such as optical imaging, molecular breast imaging, positron emission mammography, and electrical impedance tomography are being used by doctors around the world to get a more precise and accurate diagnosis.

Since breast cancer has a high chance of spreading to bones, many bone targeted drugs have been developed to prevent the spread of cancer to the bone. Using nanoparticles, chemotherapy can target the cancer cells directly, without hurting the tissue around them. That would make the drugs more effective and cause fewer harmful side effects. There are several drugs approved for use. Others are being tested.

Q. Are breast cancer patients in India able to enjoy the benefits of these advances?

We used to treat all HR+ patients with chemotherapy post-surgery, but the same does not hold true anymore. Earlier we had to send these surgical blocks to the US for a western developed test risk stratification which was affordable for less than 1 per cent of patients. Now, we have got the CanAssist Breast model based on 5 IHC markers and a machine learning-based algorithm, which has been developed and validated on Indian patients and correlated with the already available western tests which guide whether chemotherapy will help or not. This test is very much affordable by larger population.

Small molecules in the form of tablets are now available in India for breast cancer management.

Breast cancer burden in India

Breast cancer is also the most common cancer diagnosed among Indian women. Sadly, the number of cases continue to increase every year, especially in urban India. Health experts blame it to the increasing lifestyle issues like overweight, too much calory consumption, low exercise, and changing reproductive preferences.

The Indian Council for Medical Research (ICMR) in its report on the 'Burden of cancers in India' released early this year, cautioned that the number of Indians suffering from cancer may increase to 29.8 million by 2025, from current 26.7 million. The report also listed seven cancers which account for over 40 per cent of the total disease burden. These include lung cancer (10.6 per cent), breast cancer (10.5 per cent), mouth cancer (5.7 per cent), liver cancer (4.6 per cent), stomach cancer (5.2 per cent), oesophagus cancer (5.8 per cent), and cervix uteri (4.3 per cent).