by Dr. Ashok K. Vaid
Breast Cancer: these words conjure up deep dread. The moment they are uttered, the world collapses for patients and family members, and the intense emotional and physical toll begins. Breast cancer is the most common cancer worldwide, with nearly 1.7 million new cases diagnosed in 2012 . Collectively, the US, India and China account for almost one third of the global breast cancer burden and the survival ratio in India is the worst: in 2012, 144,937 women were detected with breast cancer in India, of which 50% died of breast cancer, making the ratio 1:2, compared to 1:4 in China and 1:6 in US.
The good news is that innovation is changing things for the better. In recent years, researchers have made significant strides into finding a cure for this cancer. Doctors are moving beyond the standard procedure of a lumpectomy or mastectomy, followed by radiation, and new therapeutic treatments are being explored to check this and other cancers. Innovations is helping improve clinical outcomes and decreasing suffering.
The most promising is the new frontier of cancer immunotherapy, where a lot of work is going on worldwide. This approach relies on harnessing the body’s own immune system to fight malignant cells, and presently more than 100 clinical immunotherapy trials are underway globally. Many Immunotherapy drugs are being developed, and early reports look promising. While these treatments are currently very expensive and beyond the reach of most patients, work is on to make these breakthrough medicines available to more patients worldwide, at affordable costs.
Less is more
The ‘less is more’ approach is gaining momentum and it is based upon the acceptance that every manifestation of breast cancer is different. Breast cancer is not one cancer but a group of more than a dozen biologically different diseases. Proponents of this approach, led by the experts at Anne Arundel Medical Center, USA, are trying to do away with aggressive surgery, and reducing chemotherapy and radiation treatments from six weeks to three weeks or less. Adaptive therapy is gaining ground, to combat tumours with lower doses, to prevent death, but also reduce the suffering that results from aggressive treatments. Doctors are also optimistic about metronomic therapy, which focuses on making dose sizes tolerable and administering medicine orally when possible. Trials at Fred Hutchinson, USA, are going on now.
Oncoplastic surgery, which combines cancer surgery and plastic surgery techniques to reshape the breast at the same time, is coming up fast. Proton therapy is also gaining ground using a typical beam with protons, which are positively charged particles, to eventually destroy cancer cells.
The medicinal front
The significance of new medication cannot be underestimated. Hormonal treatments and new aromatase inhibitors are having an impact, while new bone-directed treatments and drugs are being developed to prevent the spread of breast cancer to the bones. Delhi-based Deepika’s breast cancer had spread to her bones, due to a delay in diagnosis; but now, while her cancer is in remission after an aggressive six months of chemotherapy, these drugs (Bisphosphonates) are helping to reduce the risk of fractures in bones that have been weakened by metastatic breast cancer. These medicines are a boon for her and, without them, her complications would have been difficult to manage.
Certainly, the discovery and use of new drugs has made a difference, but the biggest shift in chemotherapy may be in how these drugs are administered. New research is showing that a single shot of radiation therapy works just as effectively (maybe even more) and leads to far less side effects as compared to the whole breast radiation therapy which was the norm till now.
The most exciting research is going on to prevent onco-genes (cancer causing genes) from turning cells malignant and encouraging trial data is being presented. Similarly, research for the prevention and early detection of cancer is also entering a new era. Scinti-mammography (molecular breast imaging) looks promising too. Here, a slightly radioactive drug called a tracer is injected into a vein, attaches to breast cancer cells and is detected by a special camera. A report published in January, in the journal of Cancer Prevention Research, illustrates how rapid and broad-ranging the evolution of this field is. Several institutions are looking into the possibility of a cancer vaccine as well.
Finally, while many exciting treatments and detection techniques are still years away from being available for use, the milieu is optimistic and that’s what is important. We need to ensure this good work continues. We need to ensure that the drug innovators, who make it possible for us doctors to use our skills for saving lives, are allowed and enabled to continue innovating. Not only should they be applauded, they need to be encouraged as well. The future of cancer treatment rides on this.
The author is the Chairman Medical Oncology & Haematology, Medanta Cancer Institute Medanta – The Medicity
This article was originally published at the “Article” source noted above and distributed by The Tutu Project for informational purposes only.