For this year’s Breast Cancer Awareness Month, celebrities such has Serena Williams have worked to raise awareness and encourage women to go for regular check-ups.
The reason behind such campaigns is simple: The earlier cancer is diagnosed, the less likely it is to spread to other parts of the body and the more chance the patient has of survival.
In fact, survival rates have been rising steadily over the past decade. “Due to the better diagnosis and staging, the treatment of breast cancer has improved and survival rates for stages 0, 1 and 2 of breast cancer have increased from 80 per cent to 97 per cent,” says Dr Keya Rahul Shivadey, Specialist in Obstetrics and Gynaecology, Aster Clinic.
Dr Shivadey attributes this improvement in survival rates to a deeper understanding of the different stages of breast cancer. “Previously, we staged breast cancer based on the size of the tumour and number of lymph nodes affected but these days the staging is based on the hormonal receptors and the HER2 [a gene that plays a role in the development of breast cancer].”
Personal treatment paths
As the medical profession’s understanding of breast cancer has evolved so has the way the disease is treated. “It is important to understand that no two women usually have the same type of breast cancer,” explains Dr Shaheenah Dawood, Consultant Medical Oncologist, Medcare Hospital. “When we are approaching therapeutic strategies, we develop a treatment plan for a patient who has recently been diagnosed with breast cancer.” Dr Dawood says that, ordinarily, therapeutic pathways are defined by two main factors. “One is the anatomical staging of the disease, which means: Is the disease restricted to the breast and the regional lymph nodes or has it spread to other sites in the body?
“The second main point is to try and determine the biology of the disease. This is determined by the amount of biomarkers that we detect in the tumour. To give you a sense of how different biology determines a therapeutic plan, you may have a patient who has a two-centimetre tumour in the breast but the tumour is sensitive to hormones, and that particular patient may not require chemotherapy. Then you may have a patient who has a one-centimetre tumour in the breast but that patient may need chemotherapy simply based on the biology of the disease.”
Side effects of chemo
“Chemotherapy is usually given to patients in stages 2, 3 and 4 of breast cancer and for patients with inflammatory and metastatic breast cancer,” says Dr Shivadey. “In stages 0 and 1 we usually perform a lumpectomy and use radiation therapy because the lymph nodes are not involved.”
Dr Dawood explains that the well-known side effects of chemotherapy are now more manageable than previously — although this varies. “In general, for women who are treated for breast cancer, we have very advanced therapies and we have a lot of supportive measures to help women get through the side effects of chemotherapy. Most women are able to continue with their daily activities.
“We have excellent anti-nausea medication. Women are typically also very concerned about losing their hair, and the US Food and Drug Administration (FDA) approved the first cooling cap [scalp cooling system] last year. In certain cases, if the cooling cap is used appropriately, you can prevent hair loss for women with breast cancer.”
Dr Shivadey is optimistic about a recent trial, which she believes has the potential to change the way that triple-negative breast cancer is treated. “There is a promising trial for a therapy that is yet to be approved by the FDA, especially in the treatment of metastatic [advanced] breast cancer. It’s an immunotherapy that builds the body’s immune system and targets the cells that fight cancer and it has a 37 per cent better survival rate than current treatments.”
Dr Dawood is also positive about new ways of treating triple-negative cancer — a sub-type of breast cancer where survival rates are lower than other forms of the disease. “I think, in the next couple of weeks we’re going to see major changes in the treatment of triple-negative breast cancer, which has been trialled by the European Medicines Agency and the FDA. In the middle of October we are going to see some interesting data. There has already been some prelimary information about the IMpassion130 trial. It is going to incorporate a combination of atezolizumab and chemotherapy into the treatment paradigm.
“We have already seen very positive results and if it is as effective as people think, it will completely change the way manage patients with triple-negative breast cancer.”