EXCLUSIVE: Breast Cancer Awareness Month 2021: Expert lists the challenges in the treatment of Breast Cancer
The two C words that continue to wreak havoc and throw curveballs at humankind every time when we think we have got this are, COVID-19 and Cancer. Newer treatments, better strategies, and a revamped infrastructure, that is what both the lethal diseases call for, and despite many experts putting their best foot forward, things still doesn't seem to be under control.
Such is the case with cancer, while many people win the fight against it, there are still a lot of challenges in its treatment.
To mark the occasion of Breast Cancer Awareness Month 2021, Dr. Archana Dhawan Bajaj, Gynaecologist, Obstetrician and IVF Expert, Nurture IVF Clinic, lists some of the challenges that are prevalent in the treatment of breast cancer.
First, there is a persistent risk of tumour recurrence beyond 5 years of treatment despite adjuvant therapy with 5 years of endocrine agents. Recent data suggests the use of adjuvant endocrine therapy for longer durations - up to 10 years - improves survival and lowers the risk of tumour recurrence.
Second, targeted therapy in breast cancer faces the challenges of diminishing returns, increasing cancer care costs, and the risk of overtreatment. Regular follow-up exams are required to evaluate therapy side effects and detect illness recurrence, if any. Initial follow-up visits are more frequent, and the interval between them grows as time passes, until only annual visits are required after 5 years of treatment completion.
Third, the drawback of immunotherapies, especially within a combined regimen, is the occurrence of immune-related side-effects affecting different organs, such as the skin (rash, pruritus), or gastrointestinal tract symptoms, and sometimes the occurrence of life-threatening complications.
Fourth, cancer treatments with chemotherapy can lead to oestrogen deficiency via gonadal dysfunction, and also impair bone health. In the treated radiation field, radiation can compromise bone integrity. Hormonal therapy to induce hypogonadism has also been linked to rapid bone loss.
Fifth, chemotherapy usually consists of 6-8 cycles given every 15-21 days in a day care setting. Hormone therapy in the form of tablets might last up to 5 years. A type of targeted therapy may be needed and is typically given for a year. Chemotherapy can cause side effects such as hair loss, nausea, vomiting, and weakness, although the majority of these can be managed with contemporary medications.
Sixth, breast cancer patients opt for oncoplastic surgery for conservation. Even if the breast needs to be removed, it can be restored with or without synthetic implants using the patient's own tissues. Arm swelling (lymphedema) may develop in 20-30 percent of patients following complete removal of lymph nodes from the armpit. Lymphedema rates can be reduced to less than 5 percent with newer procedures such as Sentinel lymph node biopsy and Lymphovenous anastomosis.