Breast Cancer-12

BREAST CANCER PART-12

Welcome to part 12 of educational series on breast cancer. In part 11, we learned about most advanced developments in this field, with targeted therapies like herceptin, trastuzumab, lapatinib, and how they are changing the way we treat breast cancer.

Question: Thank you Dr. Chiragbhai. In last 3 parts, our readers have learned about advances in surgery, chemotherapy, and targeted therapies. Are there any other advances that women can benefit from in this increasingly common cancer? In fact, since I started working with you on this series, I have heard about or met several patients with breast cancer, many of whom were treated several years ago, and are now free of disease leading a normal life.

Answer: I agree. There are many such patients with breast cancer. We do not have numbers for India, but in USA alone, there are more than 10 lakh breast cancer survivors. This itself is an evidence that one can get very positive results in breast cancer, especially if diagnosed early.

And yes, there are two other important advances in treatment i.e. in hormonal therapy and in radiotherapy.

Que: You mean there is something more than Tamoxifen?

Ans:. Yes, after so many years, there are aromatase inhibitors i.e. arimidex, letrozole, and exemestane. These drugs are more effective compared with tamoxifen, and are already in widespread clinical use for over 5 years. Also, they are not associated with two uncommon but serious side effects of tamoxifen i.e. deep vein thrombosis and uterine cancer. However, they can be used only in postmenopausal women.

These drugs are so effective that they are used as sole preoperative treatment in elderly frail women, with good tumor shrinkage without chemotherapy. They have also replaced tamoxifen in most cases for postoperative treatment.

Also available are estrogen antagonist Fulvestrant, LHRH agonist Goserlin and few others. These are mainly used in metastatic cancer today.

Que: What about Radiotherapy? Is that also getting better?

Ans: Of course. With advances in software and hardware, radiotherapy precision has improved considerably. Hence now we are able to deliver more dose, at the same time with less side effects. Exposure to heart and lungs is markedly reduced. Because of these advances, radiotherapy now adds to survival, especially so in patients with positive axillary nodes. Radiotherapy should be given after systemic chemotherapy in almost all cases. Sandwiching it between chemotherapy cycles is no longer practiced.

Remember also that lumpectomy (partial breast removal), also known as breast conservation surgery is not possible without radiotherapy. With improved techniques e.g. IMRT and IGRT, cosmetic results of post BCS radiotherapy have improved significantly. This is an important aspect in widespread adoption of lumpectomy.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA),
Diplomate American Board of Oncology and Hematology.
Ahmedabad. drchiragashah@gmail.com
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. 079 26754001 www.shyamhemoncclinic.com