Breast Cancer : Advances in Diagnosis and Treatment that may change the course of the Disease

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  • Monday | 21st November, 2016

Summary: 1,000 buses impoundedDuring the meeting, Mr. Baijal was also informed that the department had impounded around 1,000 unauthorised buses since January.

By Dr. Madhuchanda Kar
 
The incidence of breast cancer is increasing in India. It is becoming the number one cancer in women, pushing cervical cancer to the second spot. It is reported that 1 in 22 women in India is likely to suffer from breast cancer during her lifetime. (In America it is 1 in 8).
However, there is good news: with the number of women doing mammograms and self-breast examination on the rise, the chances of early detection have markedly increased. New research and treatments are showing positive trends to lower the death rate from breast cancer each year. Thus, there is more hope for breast cancer patients to live longer with good quality of life.
Following are a few advances in the diagnosis and treatment of breast cancer which may change the course of the disease in future:
 
Digital Mammography:
Mammography, i.e. X-ray of the breast. It can reduce death rates from breast cancer by 20-30 per cent. Now, full-field digital mammography is available which takes a digital image instead of a conventional film picture, thereby improving their ability to detect small lesions hidden in dense breast tissue. 
Oncotype DX and Mammaprint are genetic tests. In this, the biopsied sample of breast tissue is studied for its genetic makeup. They can predict the recurrence of cancer and effectiveness of chemotherapy agents in that patient.
 
Short courses of radiotherapy:
The whole breast radiation after surgery had many disadvantages like damage to normal tissue, daily hospital visits for six to seven weeks for treatment.
This is done with a device like MammoSite. Doctors place a balloon to the cavity formed after removal of cancer. They attach it to a catheter that remains outside the body. At the time of radiation, a measured dose of radiation is given while limiting exposure to normal tissue. Post treatment, the deice is removed through the same old incision.
 
Surgery:
Thanks to better early detectionmethods, more breast cancers are being detected at an early stage. Newer breast-sparing surgical techniques are evolving. Doctors are working on keyhole (endo-scope) procedure for mastectomy. In future, it will help patients in making decisions about treatment.
 
Targeted therapies:
Breast cancer with overexpression of HER2 in the cancer cells is an aggressive variety of breast cancer. About 30 per cent patients respond to transtuzumab (Herceptin) with chemotherapy. Efforts are on to block the signals that regulate the growth of the tumour more comprehensively. Pertuzumab is an investigational drug which blocks the HER3. When given along with Herceptin (that blocks HER2 receptor) and chemotherapy, it showed that patients lived longer without their disease getting worse compared to those who only received Herceptin and chemotherapy.
Women for whom Herceptin with chemotherapy doesn’t work or stops working: these tend to be fairly bad and patients run out of options. T-DM1 is an investigational drug, which is like ‘Trojan Horse’ therapy in which Hercepting zeroes in on the cancer cells and delivers a chemotherapy agent that stops cancer cell division. In near future, the availability of these and more agents will increase survival even in advanced breast cancer.
 
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Dr. Kar is consultant medical oncologist at Apollo Gleneagles Hospital, Kolkata.

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