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Treatment for Breast Cancer: Everything You Need to Know!

Treatment options for breast cancer.

treatment for breast cancer

The breast cancer awareness month is about to get over in a few more days. But before we all get excited about Halloween and the month of November, let's take a step back and address a critical problem associated with this condition - surviving breast cancer once you are diagnosed.

This is Part 2 of our interview with the renowned radiation oncologist, Dr. Upasna Saxena, MD of the HCG Apex Cancer Centre in Mumbai on breast cancer. If you missed Part 1, you can read it here.

Interview Highlights You Should Not Miss:-

  • Why India has a 50% mortality rate in breast cancer even though countries like China and USA, where there are more diagnoses every year, only have 16 - 25% mortality.
  • Breast removal surgery and what women can do once it has scarred them for life.
  • The reason why silicone implants are not preferred for breast reconstruction after mastectomy.
  • And a fantastic gene tool that can accurately detect if you need chemotherapy or not.

So without further ado, let's dive in.

Ria: If we look at the statistics from the WHO report of 2012, there were 144,937 new breast cancer diagnoses in India in the year 2012. That is not as big as the 187,213 diagnosed in China or the 232,714 diagnosed in USA. Nevertheless, the mortality rate in India (because of breast cancer) was almost 50%, while both China and USA had a far lower mortality rate (1 out of 4 and 1 out of 6 patients, respectively). What is the reason behind this dismal figure?

Ria: If we look at the statistics from the WHO report of 2012, there were 144,937 new breast cancer diagnoses in India in the year 2012. That is not as big as the 187,213 diagnosed in China or the 232,714 diagnosed in USA. Nevertheless, the mortality rate in India (because of breast cancer) was almost 50%, while both China and USA had a far lower mortality rate (1 out of 4 and 1 out of 6 patients, respectively). What is the reason behind this dismal figure?

Dr. Upasna: I will quote a few figures that will explain a lot of things to you.

If you look at the UK website where they show their data, you will see that there has been a rise in the incidence [of breast cancer] since 1930 by about 19-20%. This rise is because of lifestyle changes.

The other thing you will see is that UK's breast cancer survival rate has doubled in the last 40 years. So the most important thing that differs between their patient profile and our patient profile is the time of diagnosis.

For them, 79 - 87% patients are diagnosed in stage 1 or 2, while only 13 - 21% are diagnosed at stage 3 and 4. And only 6 - 7% are metastatic at the time of diagnosis.

This is because over the years there has been a significant increase in awareness [of breast cancer]. It's a topic which is spoken about. Plus, people there regularly undergo screening because their society does not have such a strong taboo against talking about breast or cervical cancer.

The moment you get a patient in stage 1 and 2, you get a very good survival. So their overall patient statistics show very good survival.

But if you look at the whole world's scenario, the survival after 5 years drops to 89%. Why? Because here we have all the other countries, like India, where the survival is low, or the African countries where the facilities are not so advanced.

That affects the whole statistics.

The number one reason why the survival rate in these countries is low is that there is a huge social taboo. People are not educated or aware that they need to take care. They don't know about it. They don't want to talk about it. And they are shy when they even hear about it.

In fact, even a lot of patients from the educated class, as we have seen, overlook symptoms they observe and don't go because they are shy. Plus, they don't go for regular screening.

We are still trying to train our masses that screening is very important so that we are able to catch cancer at stage 1 and 2.

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Ria: Is the screening expensive?

Ria: Is the screening expensive?

Dr. Upasna: It's not that expensive. And you have to do it once in a year. So it's hardly anything.

Plus, when you screen regularly, you will catch a tumor that you cannot detect by your hand. As a result, you will have very high cure rates.

But there are a lot of social, logistical, and financial factors.

What happens in UK and US is that it's all government-aided over there. So if any patient is diagnosed, they take the right treatment through.

Over here we have patients who do not come for treatment because of the cost factor, who come but are not able to complete the treatment, and who do not get social support to come and get the treatment. So there are multiple factors.

In fact, our data says that the survival rate is less than 60%, for the cases that are reported in the cities. Plus, more than 50% of patients in India are diagnosed at stage 3 and 4. So our whole statistics topples down.

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Ria: So what are the various treatment options for breast cancer available in India?

Ria: So what are the various treatment options for breast cancer available in India?

Dr. Upasna: All the treatment options for breast cancer are available in India.

Whether they are various types of surgeries, different chemotherapy drugs, immunotherapy, hormonal therapies, or radiation therapies - both external beam and brachytherapy - all treatment modalities are available in India.

It's just about the number of centers, the awareness in people, and the financial factor.

Ria: Can you tell us a little bit about the procedure of mastectomy?

Ria: Can you tell us a little bit about the procedure of mastectomy?

Dr. Upasna: Mastectomy is a procedure where you remove the complete breast tissue. All the glands, nipple-areolar complex, and all the other tissues.

There are different types of it.

One is radical mastectomy, where you remove the complete breast with all the lymph nodes that are draining it, like the ones in the underarm, and also the muscles of the chest wall. But these days the chest wall muscles are spared.

Then there is simple mastectomy where the breast is removed without the lymph nodes. It is done for non-malignant tumors.

Also, because of psychosocial effects and body-image factors, you can spare the nipple and the skin and do a reconstruction later so that the patient's whole life is not affected as much.

[Basically] there are a lot of surgeries, but the surgery chosen varies from case to case, depending upon the size of the disease, the age of the patient, and the patient's own interest. Plus, in some cases, you only do a lumpectomy. That is, just remove the lump and its margins without removing the breast. This is known as breast-conserving surgery.

Ria: So how does mastectomy affect the individual's life? In terms of health, social stigma, and others?

Ria: So how does mastectomy affect the individual's life? In terms of health, social stigma, and others?

Dr. Upasna: It has a significant effect psycho-socially. More than any other factor.

Medically speaking, there are just two things. One, some patients have a risk of developing a swelling in their arm on the side of the surgery. This is known as lymphedema. It does not happen in every patient, but it happens in a few. So after surgery, they are advised certain exercises that prevent it.

But those who do develop the swelling will need other treatments, like pressure devices and physiotherapy. These are the physical changes.

Apart from that, there are a lot of effects on the psychology, the body image, social comfort level, and personal life. These are the reasons why breast conservation surgery is done wherever possible. In fact, when only a lump is removed, it only reduces the size of that breast. So the patient does not lose the entire breast.

Ria: What are the various rehabilitation options available to women who have undergone mastectomy?

Ria: What are the various rehabilitation options available to women who have undergone mastectomy?

Dr. Upasna: They have to undergo physiotherapy and exercises to prevent lymphedema. But other than that, there are various measures [to rehabilitate] the lost breast tissue.

For example, the simplest measure is to wear garments that mask the effect of mastectomy. So you have certain centers which take orders, meet the patient, and make garments according to the patient's body. So when the patient wears this garment you cannot make out that the complete breast has been removed.

The other option is reconstruction. In reconstruction, they take some muscle from some other part of the body and then reconstruct the shape of the breast at the site of surgery. Once again, it gives the same effect.

The third option is to do a skin and nipple-sparing procedure, where they take tissues from some other part and place it under the skin and nipple. So it appears like a normal breast.

And all this can be avoided if the patient is a candidate for breast-conserving surgery. In fact, most surgeons prefer doing that these days for patients who qualify for it depending on the status of their disease. In this, the tumor is removed with the margins and lymph nodes so instead of losing the whole breast there is only a slight reduction in its size.

Ria: What about silicone implants? Is it not advised for reconstruction?

Ria: What about silicone implants? Is it not advised for reconstruction?

Dr. Upasna: See, silicone prostheses do not have a strict no. But there are mixed reviews.

Surgeons prefer reconstruction over silicone devices because you need to keep assessing the patient regularly. And silicone prostheses have certain other complications as well. Like if it ruptures or shrinks, then re-surgerywill be needed. Plus, they are not preferred for those patients who need radiation therapy.

Nevertheless, there are no absolute contraindications against silicone devices.

Ria: So which treatment option has the best survival rate?

Ria: So which treatment option has the best survival rate?

Dr. Upasna: Breast cancer is a condition in which most patients require all. Surgery, chemotherapy, radiotherapy, and hormonal therapy. So it is a combination [treatment] unless the doctor decides to skip chemo, or it's a very early disease, or the disease is inoperable.

Ria: What is your opinion on Mammaprint? The RNA tool that can detect high risk breast cancer cases even when they are diagnosed as low risk by conventional techniques. Is it in use or is it still in the clinical trial stage?

Ria: What is your opinion on Mammaprint? The RNA tool that can detect high risk breast cancer cases even when they are diagnosed as low risk by conventional techniques. Is it in use or is it still in the clinical trial stage?

Dr. Upasna: It's very much in use. And it's a very effective tool.

Usually, we use Mammaprint for those patients who have avery early disease, like T1, T2, and N1, N0 patients. In them, we do a Mammaprint study, which studies around 70 genes. There are other genetic tests as well. And also sometimes in patients who seem to be at high risk and require chemotherapy.

If Mammaprint suggests the patient does not need chemotherapy, then chemo can be removed.

Ria: Do we have these tools in India?

Dr. Upasna: Yes. We do have them.

Ria: Is it very expensive?

Dr. Upasna: It's very expensive. But there are other cheaper gene tools also available.

Ria: What are your views on prophylactic mastectomy?

Ria: What are your views on prophylactic mastectomy?

Dr. Upasna: If a person is highly-predisposed to breast cancer because of BRCA1 and BRCA2 [mutations], they can prophylactically get their breasts and ovaries removed before cancer develops. Like Angelina Jolie got it removed.

It's a very personal decision.

They can also opt for more aggressive screening [techniques] to catch the cancer early.

Ria: One last question. Since the breast cancer mortality rate is quite high in India, is there anything you would like to let the public know?

Ria: One last question. Since the breast cancer mortality rate is quite high in India, is there anything you would like to let the public know?

Dr. Upasna: People should overcome the taboo of talking about breast cancer. They should go for regular screenings instead of just taking it lightly. And they should encourage such conversations with their children as the real impact of urbanization will keep appearing in the next few years and decades.

So it's very important for people to be aware, make their children aware, and stop shying away from the diagnosis or the disease.


I enjoyed interacting with Dr. Upasna Saxena for this interview and hope you found this piece helpful.

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