Breast cancer is the most commonly diagnosed cancer type among women worldwide and is the leading cause of death among women. More than 2.3 million cases of breast cancer are reported each year, making it the most common cancer among adults.
Breast cancer ranks as the first or second leading cause of cancer death in women in 95% of countries. However, breast cancer survival rates vary widely between and within countries. Alarmingly, almost 80% of deaths from breast and cervical cancer occur in low- and middle-income countries.
A 2020 study by the International Agency for Research on Cancer found that of the 4.4 million cancer-related deaths among women, about 1 million children were orphaned. Remarkably, 25% of these orphans lost their mothers to breast cancer. Children who lose their mothers to cancer often suffer lifelong health and educational disadvantages, often leading to chronic social chaos and economic hardship.
Dr. Vaishali Zamre, Director and Director, Breast Cancer Center, Andromeda Cancer Hospital (Sonipat) and Dr. Rohan Khandelwal, Chief Consultant and Director, Breast Cancer Center, CK Birla Hospital, Gurugram, speak to First Post about various aspects surrounding this topic. shared their insights.
How important is early detection to improve breast cancer survival rates? What role does mammography play in this?
Dr. Zamre: Breast cancer is the most common cancer affecting women worldwide. Advances in treatment have significantly improved survival rates. Currently, with modern treatments, the five-year survival rates for stage 1, stage 2, and stage 3 breast cancer are 95%, 92%, and 70%, respectively. The importance of early detection for better outcomes cannot be overstated. Not only is the survival rate higher, but the cost and duration of treatment are also reduced. Patients diagnosed early do not need to have a complete mastectomy.
Mammography plays an important role in early detection. A properly performed mammogram can detect abnormalities that indicate cancer, such as abnormal-looking microcalcifications or small suspected lumps, long before they can be felt with the fingers. Cancers that have no clinical symptoms and are diagnosed only by mammography are classified as stage 0 cancers. These cancers have an almost 100% survival rate after treatment. 3D mammography, an advanced mammography technology, has been shown to improve cancer detection rates by nearly 50-55%. The introduction of artificial intelligence in breast image processing has further improved breast cancer detection rates.
Some studies link hormone replacement therapy to an increased risk of breast cancer. Can you share the latest research on this and give advice to women considering or currently using HRT?
Dr. Khandelwal: HRT, or hormone replacement therapy, is given to women who have reached menopause and typically includes both progesterone and estrogen in different doses. Therefore, there is an increased risk of breast cancer compared to the general population, especially when given for a long period of time. It should be reserved only for women with the main symptoms of menopause and should not be administered to all patients.
How have advances in AI and 3D mammography improved breast cancer detection? Are these new technologies widely available, and how do they compare to traditional mammograms?
Dr. Zamre: There is no doubt that this advanced technology will greatly help improve the accuracy of breast imaging results and save reporting time, but at this time, the full implementation of AI in breast imaging reporting is not ethically supported. legal and legal dilemmas exist. In our country, such advanced technology is not widely used. It is now available in major cities and major medical institutions.
Given that 1 in 8 women will develop breast cancer in their lifetime, what precautions should women take to reduce their risk?
Dr. Khandelwal: Breast cancer risk factors are divided into modifiable and non-modifiable risk factors. Modifiable risk factors are those that you can manage yourself: excessive weight gain, smoking and alcohol should be avoided, and in the case of breast cancer, breastfeeding can play a preventive role.
Genetic predisposition, lifestyle, and environmental factors all play a role in breast cancer risk. Can you talk about the most common risk factors today and how women can proactively manage them?
Dr. Zamre: The most common risk factor for breast cancer is female sex. Being a woman poses the greatest risk for developing breast cancer. As far as modifiable risk factors are concerned, lifestyle-related factors such as high-calorie diet intake, obesity, physical inactivity, and unsupervised use of hormonal medications are some of the important factors that pose additional risks. Although there is no surefire way to completely prevent the development of breast cancer, women can reduce their risk by watching their diet, incorporating fresh vegetables and fruits, avoiding high-fat and processed foods, and eating regular You should incorporate physical activity and avoid consuming excessive amounts. Over-the-counter medications without a valid prescription.
What are the latest treatments for triple-negative breast cancer, which tends to be more aggressive and difficult to treat?
Dr. Khandelwal: Triple negative breast cancer is considered to be an aggressive type of breast cancer when compared to other molecular biology. Recently, immunotherapy with pembrolizumab and targeted cancer therapy with some drugs have become available in combination with chemotherapy drugs.
Genetic mutations such as BRCA1 and BRCA2 significantly increase the risk of breast cancer. What specific measures should women at high genetic risk consider?
Dr. Zamre: Women who carry high-risk genetic mutations, such as BRCA 1 or 2, should consult a breast oncologist or genetic counselor. In such sessions, specific risk mitigation strategies are discussed. Removal of both breasts and both fallopian tubes and ovaries has been shown to significantly reduce the risk of developing breast or ovarian cancer in the future (almost 95-98%). However, such surgery is recommended for high-risk women who are over 40 years old and have children. For women younger than this age, or those who do not desire this surgical risk reduction strategy, we recommend tamoxifen 20 mg once daily to reduce the risk of future breast cancer. However, there are many studies on the use of tamoxifen in this population, with mixed results. Additionally, there is no agreement on how long this drug should be used. It was also discovered that there were compliance issues. For patients who do not want both surgical and medical risk reduction methods, a thorough examination in the form of an annual mammogram or breast MRI (depending on the woman’s age), or a clinical breast exam every six months. We recommend careful monitoring. This is done for breast cancer surveillance. There is no reliable test for monitoring ovarian cancer.
Despite significant awareness efforts, many women still avoid or delay testing. What are the common barriers to breast cancer screening and how can public health campaigns more effectively reach at-risk groups?
A common barrier to breast cancer screening is a lack of awareness and hesitancy on the part of women these days. Talks about public health awareness campaigns should be organized so that women understand that this is something they can and should discuss freely.
In recent years, immunotherapy and targeted therapies have emerged as treatment options. Can you explain how these new treatments differ from traditional chemotherapy and their impact on patient outcomes?
Dr. Zamre: Breast cancer cells have a variety of receptors on their cell membranes or in their nuclei. Many different molecular subtypes of breast cancer can be recognized based on the presence or absence of these receptors or amplification of these genes. Her 2 neu is one such receptor, and when found to be present on breast cancer cells, its specific subtype becomes responsive to targeted drugs. Targeted anticancer drugs work by targeting these receptors on cancer cells, helping them grow and survive. There are many types and generations of anti-Her 2 targeted drugs. These have been shown to improve breast cancer outcomes when used with or without chemotherapy.
Immunotherapy uses the immune system to fight cancer. It works by helping the immune system recognize and attack cancer cells. Immunotherapy drugs such as checkpoint inhibitors, cytokines, and cancer vaccines can help improve breast cancer outcomes in appropriately selected patients. Oncologists perform certain tests to understand whether a particular patient is suitable for immunotherapy. Immunotherapy drugs are used at different stages of breast cancer. For example, it is used preoperatively with chemotherapy before surgery, or post-operatively, as adjuvant therapy with chemotherapy. They are also used in the metastatic stage of breast cancer, with mixed results.
