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The evolution of breast cancer treatment

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Dr Vipin Goel, Consultant and Laparoscopic surgeon, Dept of Surgical Oncology, Basavatarakam Indo American Hospital, Hyderabad reviews how technology has changed breast cancer treatment over the years

 One of the key rituals of my morning routine is to read updates in the field of science and technology on my iPad. I do it as I am getting ready for work and this piece of technology helps in getting all updates and information in one place. Adopting this technology has really made my life simpler.

If you look at some of the other technology-driven solutions that exist in our world, you will realise how they have been able to help us lead an efficient life. Examples of some such solutions are the 4G technology providing faster internet speeds, social media channels like Instagram helping us connect and our ability to call a cab with the click of a button using Uber. In the present time, we have started considering these amenities as a granted service that has been around for many years now. The most fascinating thing here to realise is that ten years back, none of these options were around with us and we were leading a completely different life. They have started existing now to make our lives easier.

These advances have happened in the field of cancer too, specifically in the space of management of breast cancer. A good approach to talk about these developments is to talk about various steps during breast cancer treatment and to look at advances in each treatment protocol.

Screening

Breast cancer treatment has come a long way in terms of individuals being proactive about it rather than reactive. Celebration of the breast cancer awareness month has made people realise the significance of catching the disease early. There has been tremendous technological development in the space of breast cancer screening with the introduction of tools like the NIRAMAI, an AI based handheld device which can perform mass scale screening in rural and semi-urban areas.

Sentinel lymph node biopsy

In today’s time, most of the surgeons practice sentinel node mapping which is a technique that clearly tells us which node is affected by the tumour and only those can be taken out rather than all the nodes. This has reduced the incidence of lymphedema to 5 per cent from an earlier incidence of 20 per cent when all nodes were being removed.

Breast conservation surgeries (BCS)

In the past, the mainstay of surgical intervention in the case of breast cancer was a mastectomy. This would hinder the confidence of a breast cancer patient to soon go back to her normal life. Now based on the stage of the disease, breast conservation surgery is possible (lumpectomy). Many studies have shown lumpectomy is equal to mastectomy for local disease control. Lumpectomy gives better cosmetic outcomes and boosts the confidence of the patient to live her life normally.

Breast reconstruction

The process of breast reconstruction surgery has become easier with low complication rates. The aim of oncoplastic surgery is, optimising cancer cure while maintaining the shape and symmetry of the breast. In the earlier days, breast surgery could have led to breast deformity or the possibility of shoulder dysfunction. Oncoplastic surgery is divided into volume replacement and volume displacement. Volume displacement surgery involves maintaining contour by moving the remaining breast tissue. Volume replacement surgery involves moving tissue from the abdomen or back to reconstruct the breast.

Hereditary breast cancer syndromes

With the commercialisation of next-generation sequencing technology (NGS technology), now we can find out more genes associated with various breast cancer syndrome. The identification of BRCA 1 and 2 genes along with the panel of other genes is helping patients deploy measures like regular screening/follow-up and prophylactic surgeries. This is reducing the chance of cancer recurrence and incidence of newer cancer in the family.

Preventing over treatment (avoiding chemotherapy)

ER+ and HER2 early-stage breast cancer patients can avoid chemotherapy and the side effects which the chemotherapy has on the patient. This era of de-escalation of treatment has been made possible with the use of tests called prognostic tests which can provide a risk score to the tested patient about cancer recurrence. These tests are now part of international guidelines and used routinely in the USA and Europe to decide which patients don’t need to be over treated. In India, there is a test CanAssist Breast developed by a Bangalore-based company, which has been validated by major hospitals. If the score is less than the 15.5 marks, it is considered a low-risk patient and the patient can avoid chemotherapy and its side effects. This leads to a better quality of life for such patients. If the risk score is above the 15.5-mark, chemotherapy should be administered as there is a chance for cancer to come back.

Targeted therapy

There has been no oral option in the class of targeted therapy until now. The PARP inhibitors which have shown benefit in treating ovarian cancer can now be used to treat breast cancer patients. There is a qualifying criterion where patients who have mutations in their BRCA genes are the candidates to receive this oral form of targeted therapy.

Next- generation monoclonal antibodies

Historically Trastuzumab (Herceptin) has been the gold standard for treating HER2 positive breast cancer patients. It works by targeting the HER2 receptor, preventing cancer growth. Now we have newer monoclonal antibodies (Pertuzumab/Perjeta, Kadycla) which have shown promise to further make treatment of breast cancer a much efficient process.

We are witnessing new breakthroughs in the space of cancer treatment and it is our responsibility to assess these technologically advanced treatment tools and extend the benefits to our patients.

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