In India, 60-70% of patients present in advanced stages due to various reasons. In the West, the numbers are at 20-30%. Breast cancer is a potentially curable disease and after completion of appropriate standardised treatment, a patient’s life is almost like normal healthy individuals
By: HBI Desk
An interview with:Dr. Rashmi Sudhir, Senior Consultant Radiologist, Breast Imaging and Intervention Specialist, Basavatarakam Indo-American Cancer Hospital & Research Centre, Hyderabad, India
Kindly tell us in detail about the latest treatments and technologies available for treating breast cancer?
Breast cancer diagnosis and treatment have evolved tremendously over the last two decades. 3D- mammography or digital breast tomosynthesis (DBT) is the latest imaging technology for the breast cancer diagnosis, which has significantly improved the diagnostic accuracy of breast cancer detection even in women with dense breasts.
In this technology, multiple thin slice images of each breast are obtained and reconstructed into standard mammographic views, which help in the detection of small hidden cancer in the breast by reducing the superimposition of normal breast tissue. The Amulet Innovality from Fujifilm is one such technology, which has ability to detect breast cancer in early stage and the cancer detection rate 30-41% higher than the conventional 2D-mammography.
From the treatment point of view, the biggest change has been the shift from complete removal of breast (mastectomy) to breast conservation surgery (BCS) in which only the breast lump is removed and radiation therapy is given to the remaining breast after surgery. Another big change is the evolution and acceptance of sentinel lymph-node biopsy. Both combined, most patients of breast cancer surgery are able to get discharged from the hospital in a day or two. For few patients in whom complete breast removal is required, excellent breast reconstruction options are available in which an artificial breast mound is created using patient’s own tissues from different part of the body, which provides good cosmoses in terms of breast size and shape.
The other traditional treatment modalities of chemotherapy and radiation therapy have seen vast improvements in delivery and management of adverse effects. Newer drug developments have taken place in the form of hormonal treatment, targeted molecular treatment and immunotherapy with lesser side effects.
Tell us what makes them more patients friendly.
Many of the patients complain that mammography is a painful examination because of breast compression. With the recent advancements in mammography technology, 3D-digital mammography images can be acquired with relatively less compression force (approx. 40-50% of the standard) with no negative effects and higher diagnostic accuracy compared to the conventional mammography, and thus is not a painful examination anymore.
Now the myth of removal of whole breast for breast cancer is outdated. Conservation of breast is the primary goal. Every patient has the right to conserve the breast when feasible. So according to the wish of the patient, now the treatments are personalised and standardised without any compromise on its overall outcome.
In India, awareness is still dismal and there is a taboo surrounding breast cancer screenings. How can we overcome these hurdles?
Early detection is the key. Some causes of concern are lack of screening programs, awareness deficits, familial and social stigma, lack of priority given to a women’s health and family support, financial constraints, poor access to healthcare facilities and late presentation at the breast clinic due to various reasons or myths. For instance, if there is an unmarried daughter in house, the mother is reluctant to get medical attention as news of her disease may cause hurdle in her daughter’s marriage as she will be seen as a carrier of disease. Thus, most women neglect their health for their family, consider themselves as secondary and seek care only when the disease has advanced.
Very low awareness about breast self-examination (BSE) also leads to late presentation of patients with breast cancer and in advanced stage. A very limited access to appropriate treatment, and limited knowledge of health professionals are also major barriers to cancer prevention and detection in developing countries.
The hurdle of taboo associated with breast diseases, especially in India, can be overcome by women empowerment starting within the family and continuing that within the community, making our society educated about the breast diseases and treatment options available. There is an urgent need to explore the drivers of awareness deficits and stigma surrounding breast cancer through different forms of media coverage, including newspapers, magazines, television and other electronic media. Other ways for early detection and treatment are participation of women in screening camps, education of self-breast examination and clinical breast examination by healthcare workers/specialists regularly.
What is the age group that should get themselves screened for breast cancer?
There are no standard screening approach or guidelines in India. Breast self examination (BSE) should begin at the age of 20 years. American College of Radiologists (ACR) recommends that women >40 years of age should undergo annual screening mammogram, preferably 3D-digital mammography if available. This should start at an earlier age in women with family history of breast cancer, 10 years prior to the age at which her first degree relative (mother or sister) was diagnosed with breast cancer.
What is the time interval at which such screenings should be repeated?
Breast self examination every month and clinical breast examination by healthcare worker/specialist every year. Women aged 40 years or more should consult an oncologist or breast surgeon and after evaluation of their personal and family history as well as clinical examination, a plan for breast cancer screening should be formulated. Most of the standard guidelines recommend screening mammography for women aged 40 to 74 years, to be done once every 1 or 2 years.
India has seen a surge in breast cancer cases, why is that?
Increase in population, changes in lifestyle like increase in alcohol consumption, smoking, increased fast food consumption, lack of physical exercise, obesity, late age of marriage, delay in first pregnancy, less number of pregnancies, use of combined oral contraceptive pills or hormonal therapy, reduced duration of breastfeeding, stress, improved diagnostic facilities with higher detection rates and gradual increase in breast awareness, are some of the reasons for increase in number of breast cancer cases in India.
What steps can be taken to curb the numbers?
The cause of breast cancer is not known. Hence, it can not be completely prevented. However, deaths occurring due to breast cancer can be significantly reduced by detecting them in early stages. Awareness with the help of media, life style modification, nationalised screening programs, improving the healthcare facilities and access to healthcare facilities at root levels can be used to curb the numbers and the deaths occurring due to breast cancer.
How helpful is early intervention in the treatment process?
In India, 60-70% of patients present in advanced stages due to various reasons. In the West, the numbers are at 20-30%. Breast cancer is a potentially curable disease and after completion of appropriate standardised treatment, a patient’s life is almost like normal healthy individuals. Early detection does not only improve the outcomes, but also drastically reduces the cost and duration of treatment. Earlier the detection of breast cancer, higher are the chances of cure.
Kindly tell us about your efforts & the challenges you face or have faced while working in this field.
Though there is no national screening programme, we have a mobile screening mammography unit. We regularly conduct screening camps at remote places. We guide the needy people to healthcare facilities for further treatment. We educate the people there, try to clear the social stigmas and motivate the public to reach healthcare facility in case of a need. Lack of awareness about breast breast diaseases in general public, social stigmas related to regular screening and treatment, continuation to regular screening, compliance to complete the treatment, lack of financial and family/social supports are the biggest challenges we are facing now.