KOCHI: Breast cancer is eating into the health of the women in the country. And going by the present lifestyle, fourty per cent of the one lakh women in the country can be affected with this disease every year, according to statistics available from major cancercentres in Kerala. This translated to 15,000 new cases of carcinoma breast diagnosed every year inKerala! In the west, the average age of breast cancer is 61 years. However, in India, cancer strikes a decade faster. An alarming trend in India is the increasing number of young women diagnosed with the disease. Urbanisation of population with lifestyle changes, breastfeeding, age of first pregnancy have all been postulated as reasons for this phenomenon.
Compared to developed countries, majority of cases are diagnosed at a later stage. More than
ignorance, it is the fear of diagnosis and treatment that leads to this situation. In an early stage, cure rate is anticipated to be above 90 per cent which drops to 50- 60 per cent as the disease advances. The only method to improve survival rates is to motivate women to report any ominous swellings at the earliest and also to encourage regular screening mammograms.
Treatment of Breast cancer or for that matter any cancer is based on guidelines suggested by bodies like NCCN,ESMO. For an early stage disease,after surgery, the tissue is analysed for risk factors for recurrence. Classically, size of the tumour, grade, spread to nodes have been taken to divide into high risk and low risk groups. High risk tumors have the propensity to spread to other organs/recur, thus making it necessary to administer chemotherapy . The flip side is the collateral damage caused by action of chemodrugs on white blood cells reducing immunity as well as loss of hair. These are reversible but can have a huge psychological impact.
Root cause of cancer is a change in genomic milieu of tissue. Scientists are looking at ‘genomic profiling’ of cancer cells. Sequencing of genes have helped to segregate cancers into those with high/low genomic risk profile. 21 gene sequencing called Oncotyoe DX and 70 gene sequencing– Mammaprint are being commonly used. Trials have shown that if the genomic risk profile is low, chemotherapy can be avoided.
Mindact study published recently assessed the clinical and genomic risk of disease recurrence in nearly 6,700 women with early-stage breast cancer.
Among patients at high clinical risk but low genomic risk who did not receive chemotherapy had a rate of survival without distant metastasis of 94.4 percent, and those with high clinical risk but low genomic risk who did get chemotherapy had a rate of survival without distant metastasis of 95.9 percent.
This means that if the gene signature were used to guide chemotherapy choice, there will be a reduction in the use of adjuvant chemotherapy in 46.2 percent of patients with only a small increase in recurrence risk. If this is suggested to the researchers, chemotherapy can be avoided for a number of patients who are at low genomic risk of recurrence. Once indigenously developed tests, tailor made for our population are available ,one can risk stratify the patients better. The era of ‘personalised cancer medicine’ seems to be just around the corner!