Is chemo right answer? How recurrence tests can help you decide
Outcomes in breast cancer are influenced by various factors, such as subtype of disease and stage of diagnosis.
BENGALURU: Outcomes in breast cancer are influenced by various factors, such as subtype of disease and stage of diagnosis. Certain subtypes such as the triple-negative subtype are known to have poor prognosis with many patients recurring within three years, whereas the hormone positive subtype is known to have excellent prognosis. Early detection is another factor that plays a key role in prognosis. In Western countries, most patients are diagnosed in early stages due to greater awareness and systematic screening for breast cancer. These early-stage breast cancer patients have a very high relative survival rate of five years after diagnosis, underlining how crucial early detection is.
There are various other short and long-term benefits of being detected in the early stages of breast cancer. Patients who are diagnosed with Stage I or II breast cancer are candidates for breast conserving surgery (BCS) rather than mastectomy. The main advantage of conservation is that a woman keeps most of her breast, thus avoiding the psychological effects associated with permanent removal. One point to note is that patients who undergo BCS have to also undergo radiation to help lower the chance that the cancer will come back in the breast.
Various studies have demonstrated that choosing BCS (plus radiation) over mastectomy does not affect a woman’s chances of long-term survival. With the latest radiotherapy technologies and specialist breast cancer surgeons now available in India, BCS is a viable option for Indian breast cancer patients who are detected with early-stage disease.
Another advantage of early detection is the ability to tailor treatment based on the results of a prognostic test. Prognostic tests analyse certain biomarkers in patient’s tumour to assess how likely it is that their cancer will relapse. In the era of personalised medicine, prognostic tests are gaining popularity in customising treatment based on each patients needs. These tests allow patients to be classified “at low risk of relapse”, therefore avoiding aggressive treatment like chemotherapy, or “at high risk of relapse” and more likely to benefit from additional treatment.
Most cancer patients undergoing chemotherapy suffer due to one or another side effect. The impact is greater on elderly patients. Given the harsh side-effects of chemotherapy, it is very important to ensure that patients who don’t need chemotherapy are not subjected to it unnecessarily. Prognostic tests that help personalise treatment are now available in India but are not widely used as they are quite expensive Recently, an affordable prognostic test, “CanAssist Breast” has been developed by an Indian company. Premier cancer hospitals and research institutions across India have participated in the validation of this test, allowing Indian breast cancer patients the opportunity to undergo a prognostic test and get the treatment best suited to them.-The author is senior consultant, medical oncology, Cytecare Hospitals