Experts stress early detection, lifestyle and technology’s role in breast cancer survival – Firstpost

Breast cancer is the most commonly diagnosed cancer type among women worldwide and the leading cause of death in women. Annually, over 2.3 million breast cancer cases are reported, making it the most common cancer among adults.

In 95% of countries, breast cancer ranks as the first or second leading cause of female cancer deaths. However, breast cancer survival rates vary greatly between and within countries. Alarmingly, nearly 80% of breast and cervical cancer deaths occur in low- and middle-income countries.

A 2020 study by the International Agency for Research on Cancer revealed that out of 4.4 million cancer-related deaths among women, approximately 1 million children were left orphaned. Notably, 25% of these orphans lost their mothers to breast cancer. Children who lose their mothers to cancer often face lifelong health and educational disadvantages, leading to chronic social disruption and financial hardship in many instances.

Dr Vaishali Zamre, Director & Head, of the Breast Cancer Centre at Andromeda Cancer Hospital (Sonipat) and Dr Rohan Khandelwal, Lead Consultant and Head of Breast Center at CK Birla Hospital (Gurugram) shared insights with Firstpost on various aspects surrounding the topic.

How crucial is early detection in improving breast cancer survival rates, and what role does mammography play in this?

Dr Zamre: Breast cancer is the commonest cancer affecting women, globally. Advancements in treatments have led to significantly higher survival rates. Presently, with modern treatment, the 5-year survival rates for stage 1, stage 2 and stage 3 breast cancer are 95%, 92% and 70%, respectively. It cannot be overemphasized that early detection is important for better outcomes. Not only does it lead to higher survival rates, but the cost and duration of the treatment is also less. Patients diagnosed in the early stage do not need to undergo complete removal of the breast.

Mammography plays an important role in early detection. An adequately performed mammography can detect abnormalities that represent cancer (such as abnormal-looking microcalcifications, small speculated masses, etc) much before these abnormalities become palpable with fingers. Cancers that do not have any clinical manifestations and are diagnosed only on mammograms are staged as stage 0 cancers. These cancers have a nearly 100% survival rate after treatment. 3-D mammography, an advanced mammography technology, has been found to improve the detection rate cancer by nearly 50-55%. The introduction of artificial intelligence in breast imaging has improved detection rates of breast cancer even further.

Some studies link hormone replacement therapy to an increased risk of breast cancer. Could you share the latest research on this and offer advice to women considering or currently using HRT?

Dr Khandelwal: HRT or Hormonal replacement therapies are given in females who are reaching menopause and it generally includes both progesterone and estrogen in different dosages. So, it does increase the risk of breast cancer when compared to the general population especially if it is given for a longer duration. It should be reserved only for those females who have major symptoms of menopause and should not be given to all patients.

With advancements in AI and 3D mammography, how has breast cancer detection improved? Are these new technologies widely accessible, and how do they compare to traditional mammograms?

Dr Zamre: There is no doubt that this advanced technology will be of tremendous help in improving the accuracy of breast imaging results as well as saving reporting time but presently there are certain ethical and legal dilemmas in total adoption of AI in breast imaging reporting. In our country, such advanced technology is not widely available. It is presently available in bigger cities and major healthcare Institutes.

Given that 1 in 8 women will develop breast cancer in their lifetime, what preventative measures should women take to reduce their risk?

Dr Khandelwal: The risk factors of breast cancer are categorised into modifiable and non-modifiable risk factors. The modifiable risk factors are the ones that one can take care of, excessive weight gain, smoking and alcohol should be avoided and breastfeeding would be the one thing that has a preventive role in case of breast cancer.

Genetic predisposition, lifestyle, and environmental factors all play roles in breast cancer risk. Could you discuss the most common risk factors today and how women can proactively manage them?

Dr Zamre: The most common risk factor of breast cancer is female gender. Being a woman, itself poses the biggest risk of breast cancer development. As far as the modifiable risk factors are concerned, lifestyle-related factors like consumption of a high-calorie diet, obesity, lack of physical activity, and unsupervised use of hormone pills are some of the important factors that pose additional risks. There is no sure way of totally preventing breast cancer from happening but to reduce the risk, women should watch their diet, incorporate fresh vegetables and fruits, avoid high fat-containing and processed food, adopt regular physical activity and avoid excessive use of over-the-counter medication without a valid prescription.

What are the latest treatment options for triple-negative breast cancer, which tends to be more aggressive and harder to treat?

Dr Khandelwal: Triple-negative breast Cancer is considered to be an aggressive type of breast cancer when compared to other molecular biologies. Immunotherapy with pembrolizumab and targeted cancer therapy with some medications are available these days along with chemotherapy drugs

Genetic mutations like BRCA1 and BRCA2 significantly increase breast cancer risk.  What specific measures should women with high genetic risk consider?

Dr Zamre: Women who are carriers of high-risk genetic mutations like BRCA 1 or 2, should consult a breast oncologist and a genetic counselor. Certain risk-reducing strategies are discussed during such sessions. Removal of both breasts and both-sided fallopian tubes and ovaries has been found to significantly reduce the risk (Nearly 95-98%) of having breast and ovarian cancers in the future. However, such surgeries are advised for high-risk women who are above 40 years of age and have had children. Women who are younger than this age or who are not willing for this surgical risk-reducing strategy are advised Tab, Tamoxifen 20 mg once a day to reduce the risk of breast cancer in the future. However, there are many studies about the use of Tamoxifen in this population with variable outcomes. Moreover, there is no consensus about the duration of use of this drug. It has also been found to have compliance issues. Patients who are not willing for both surgical and medical risk-reducing methods are advised close surveillance in the form of annual mammography and or MRI of the breasts (depending on the age of the woman), a clinical breast examination once in six months. This is done for breast cancer surveillance. There is no reliable test for ovarian cancer surveillance.

Despite significant awareness efforts, many women still avoid or delay screenings. What are the common barriers to breast cancer screening, and how can public health campaigns more effectively reach at-risk groups?

The common barriers to breast cancer screening are lack of awareness and hesitation on the part of women these days. Public health awareness talks on campaigns should be organized so that women understand that this is something that they can talk about and should talk about freely.

Immunotherapy and targeted therapies have emerged as treatment options in recent years. Could you explain how these newer treatments differ from traditional chemotherapy and their impact on patient outcomes?

Dr Zamre: Breast cancer cells have different receptors on the cell membrane or inside the nucleus. Based on the presence or absence of these receptors or amplification of these genes, many different molecular subtypes of breast cancer can be recognized. Her 2 neu is one such receptor, if found to be present on the breast cancer cell, makes that particular subtype responsive to targeted drugs. Targeted cancer drugs work by targeting these receptors on cancer cells that help them to grow and survive. There are many types and generations of anti-Her 2 targeted medications. These when used along with chemotherapy or without have been found to improve breast cancer outcome.

Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells. Immunotherapy drugs like check point inhibitors, cytokines, cancer vaccines etc help in improving the outcome of breast cancer in suitably selected patients. Oncologists carry out certain tests to understand the suitability of a particular patient for immunotherapy. Immunotherapy medicines are used in different stages of breast cancer, e.g. before surgery in neoadjuvant setting along with chemotherapy or after surgery along with chemotherapy in adjuvant setting. They are used with variable results in metastatic stage of breast cancer also.