Breast cancer in the new millennium: How are things different now

As per Globocan 2021, breast cancer is the commonest cancer in men and women. Approximately 12% of all cancers are breast cancer and it causes 7% of all cancer related deaths. Its incidence is more common in developed worlds compared to low income and developing parts of the world. However, death rate because of breast cancer is higher in developing parts of the world. In last 50 years, the number of breast cancer cases among women in United States has increased by two times and in India, the number has increased by almost four times. In recent years, incidence has been rising in younger women.

Breast Cancer Screening: What to do? It’s very interesting to know that breast cancer is one of the few cancers where screening can play a crucial role to detect the cancer at a very early stage where it can be completely cured, and the affected woman can have a long life without significant problems. For women with average risk of developing breast cancer it’s recommended that annual breast cancer screening to be started at age of 40 years and earlier in women with higher risk of developing breast cancer. Digital mammography, breast tomosynthesis, contrast enhanced MRI and molecular breast imaging are some new screening tools available nowadays. Screening is usually not recommended before 25 years of age and as of now it’s not very clear what should be the uppermost age when one should stop doing breast cancer screening. In recent years there has been some discussion about the role of breast cancer screening in transgender population; however, there is no specific guidelines as of now.

What is new in tissue diagnosis: Tissue diagnosis or biopsy is not new however the role of FNAC is rudimentary nowadays. Mostly a tru cut biopsy before treatment is recommended which helps inaccurate diagnosis and obtaining hormonal and molecular profiling of the cancer. Some genetic screening test and the mutation analysis like BRCA1 and BRCA2 are recommended in patients with strong family history, triple negative breast cancer and some other specific situations. It’s very important to know and understand that doing a breast biopsy in experienced hands does not cause spread of the cancer. At good centers, most of the time this biopsy is done under some image guidance and many a times some marker is placed to help the surgeon with future surgical procedures.

What is new in radiation treatment? This is very interesting to know that in the last decade, there has been quite a significant new development in the field of radiation treatment for breast cancer. Gone are the days when the radiation treatment used to continue for almost six to seven weeks and used to produce significant side effects. The new age linear accelerators can deliver precise radiation to the breast and/ or armpit glands whenever needed. Many women remain concerned about the risk of damage to their heart because of the late effects of radiation. There are techniques which can literally separate the heart from the field of radiation and keep the heart safe in a much better way compared to earlier days. In some selective cases particle beam therapy can also be useful for sparing the heart from the effect of radiation. Many women can complete their entire radiation treatment within three weeks. In a very select group this can be completed in one week only. However, like surgery, radiation is also a skill-based treatment, and it needs a highly trained radiation oncologist and setup to deliver search advanced radiation treatments.

Is surgery mutilating like earlier days? The simple answer to this question most of the time is “no”. In most circumstances with early-stage breast cancer, the breast is preserved, and the tumor is removed with a small margin around it. Even in some advanced stage breast cancers, breast preservation is possible with the help of chemotherapy or hormone therapy before the surgical procedure. There are many reconstruction methods available nowadays which help in maintaining a natural shape and contour of the breast. One such procedure is known as oncoplastic reconstruction. The surgeons may not need to do an extensive operation in the armpit. With the help of Sentinel lymph node biopsy (SLNB), limited number of glands are removed which helps in better maintaining the function of shoulder joint and reduce the risk of swelling of the arms which were very common in earlier days. Lymphatic reconstruction is another new procedure which helps in reducing the risk of arm swelling. So, of course the surgery he’s not so mutilating as it used to be a few decades back. The quality of life is much better nowadays.

Anything new in chemotherapy? There has been a plethora of new molecules which are effective in the treatment of breast cancer. Many of these newer molecules can be used in early and locally advanced breast cancers and some of them are very useful in stage 4 breast cancer as well. Patients with hormone receptor positive breast cancer can also be spared from the need of chemotherapy in certain situations. Studies have confirmed that this can be as effective as chemotherapy in patients with a very low risk of recurrence of breast cancer. There are some newer molecules which are also effective in triple negative breast cancer which is considered as one of the most aggressive forms of breast cancer. Patients with BRCA1 and BRCA2 cancers can get the benefit of PARP inhibitors, another new molecule available for treatment of breast cancer. Patients with stage 4 breast cancer nowadays have multiple lines of available treatments which are effective and help prolong the life. A very commonly heard word nowadays is immunotherapy. In some stage 4 breast cancers, this can be an effective treatment as well.

Pregnancy and breast cancer: Because of increasing number of breast cancers among young women, the issue of fertility preservation and pregnancy becomes important. Proper understanding, discussion with the patient, available technology and expertise can help in overcoming this issue. Many women can become successful mother even after treatment for breast cancer if everything is planned properly.

This new Millennium has brought hopes in millions of minds worldwide. This includes the healthcare professionals, patients and caregivers. Let’s take a pledge to become aware and make others aware about the newer developments which can help in early diagnosis and cure with a good quality of life.