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Why cancer recurrence tests are crucial to decide the course of treatment for a patient

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Dr Anil Heroor, Head, Surgical Oncology, Fortis Hospital (Mulund), Mumbai gives an insight into the importance of regular screening for detection of breast cancer

In India, we are now witnessing a higher number of patients diagnosed with breast cancer every year. The latest figures from the International Association of Cancer Registries GLOBOCAN 2018 database highlight that breast cancer continues to be the most common cancer in Indian women. Not only is it the leading cause of cancer, 50-60 per cent of patients diagnosed in any particular year die of breast cancer, largely because of late diagnosis.

Lack of awareness of breast cancer and dearth of screening for cancer majorly contribute to this rising pattern. Limited awareness about breast cancer screening leads to breast cancer patients approaching their doctor only when symptoms develop, resulting in detection in later stages when compared to their western counterparts. This leads to a lower survival rate compared to developed countries where most breast cancer patients get detected in early stages. Health infrastructure is concentrated in the big cities in India and therefore all patients do not have equal access to screening facilities or cancer specialists.

Another alarming trend seen in India is rising incidence of breast cancer in the younger age group (in their thirties and forties). As per Breast Cancer India, 4 per cent of breast cancer patients are between 20 to 30 years, 16 per cent are between 30 to 40, and 28 per cent fall under 40 to 50 age group. Thus, almost 48 per cent of patients are below 50 years, and majority of them fall in the age group of 25 to 40 years. More aggressive disease in younger patients in turn further increases cancer related mortality in India. Further research is required to understand exactly why the disease profile is so skewed to the younger age group in India compared to the West.

What can be done to improve cancer related health outcomes in India?

In terms of reducing the disease burden due to breast cancer, early detection is one approach to improve the survival rate.

A number of companies have developed new screening methods and tests, in recent years, to tackle this problem of late diagnosis. Employing different technologies like artificial intelligence and machine learning, these tests are built to make breast cancer screening more accessible and affordable all across India.

Increased penetration of screening can lead to more cases being detected in early stages thereby not only drastically improving the odds of successful treatment but also reducing the cost and aggressiveness of treatment.

An additional advantage of being detected in early stages is the availability of risk assessment tests that help in finding out breast cancer relapse or recurrence risk. These tests categorise patients into different risk categories which helps to personalise their treatment depending on their specific risk of recurrence.

Why is personalised medicine the new buzzword in cancer?

Personalised medicine is based on the principle that all cancers are not the same; and that a tailored approach to each individual patient is possible. Breast cancer treatment and management is driven by a new era of technological advances that have allowed experts to study the tumour at a level of detail that was unimaginable 20 years ago.

In the very early stages of breast cancer, a majority of hormone receptor-positive breast cancer patients may not benefit from chemotherapy. This makes accurate risk prediction an all-important prerequisite for effective treatment. Risk assessment tests estimate the cancer recurrence risk in early stages that further helps the patients and doctors to understand the disease better. There are multiple biomarker-based tests that do in-depth analysis of the patients tumour biology to predict risk that are available today.

Detection of patients who are at very low risk of relapse can help them to avoid over treatment in the form of chemotherapy, given its harsh and often long lasting side effects and the toll it takes on the patients’ quality of life.

Other than anxiety about dying young or leaving things undone, worry about one’s future and family members, patients often worry about the pain of treatment and the financial toxicity of cancer. Chemotherapy can affect different body parts such as the brain, hair, weight, heart, the fertility and energy levels of a person. Some of the side-effects, especially related to memory and cognitive function, can linger long after the chemotherapy has been administered. Different patients experience side effects for varying periods of time – some for weeks and months and some for years.

Knowing the patient’s recurrence risk allows the doctors to devise treatment plans that are in-tune with the patient’s prognosis, thereby, maintaining an optimal balance between the benefits and side-effects of aggressive treatments like chemotherapy. It also makes customised treatment possible while keeping the costs down in low-risk cases. These recurrence tests help the patients to save money that they would have otherwise spent on their treatment. The more aggressive the treatment the patient has to undergo, the longer their recovery takes and the longer they or their caregiver are out of the workforce.

One might wonder, as I do, what would be the case if every breast cancer patient had access to advanced technology that could help them decide the course of treatment best suited to them? As part of the medical world, our responsibility is to remove barriers that prevent women from getting proper screening, education about breast cancer, diagnosis and treatment. And if that means embracing new age technology, why not?

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