Recent medical advances have made breast cancer a highly manageable disease, especially when detected early, as in the case of stages 0-to-II cancers.
Timely treatment also minimises disruptions to the patient's daily routine and quality of life. Advancements in digitalisation have also greatly benefited women, as they can easily access information through YouTube on how to self-examine themselves and learn about breast anatomy or changes in breast structure that should be brought to the notice of specialists immediately.
Women above the age group of 20 -25 years should examine themselves monthly, and those above 40 years of age should go for mammography at regular intervals. With earlier breast cancer detection, the survival rate increases to 80 per cent (Stage 1 and stage 2), as compared to 56 per cent in Stage 3 and stage 4.
In India, however, early treatment is the exception rather than the norm. By the time most patients are diagnosed, they are already in stage III or IV of the disease, where treatment modalities are more complex. Additionally, the stigma of living with breast cancer can hamper the patients' quality of life in physical, psychological, and social terms.
Mental health counselling, family and institutional support, and new drugs and modalities can help women at all stages of breast cancer to improve life expectancy, health, and overall happiness, thus ticking all the boxes for improved life quality.
Stigma and suffering
One in 28 Indian women is at risk of developing breast cancer during her lifetime. As per a CII report, the median age for diagnosis is 46 years, and nearly half of all diagnosed women are premenopausal, i.e., relatively young compared to breast cancer patients in Western nations. The concern, though, is that at the time of diagnosis, around 70 per cent of Indian women are already in stage III or stage IV (known as metastatic breast cancer, or cancer that has spread to other parts of the body). While getting screened early may seem like an evident solution, however, low awareness and culturally ingrained stigmas still prevent many women from getting the timely help they need.
Due to cultural factors and social taboos, women do not get checked for breast cancer or share their symptoms with others, thereby leading to delayed diagnosis. Unfortunately, the pandemic has only amplified the burden of our healthcare system, magnifying these delays.
A QOL-itative approach
Focusing on patients' QOL means helping them thrive on the physical, emotional and social parameters by improving their all-around experience of the disease. New hope has also come in the form of targeted therapies that shrink or remove tumours by disabling specific proteins on cancerous cells to block their growth. These therapies, which can often be taken orally, allow patients to bypass chemotherapy and related harsh side effects. Targeted therapies are proving more effective than chemotherapy in extending the survival rates of patients with stage III or IV cancers up to 5-8 years even if a patient is diagnosed at a metastatic stage.
The rise of non-invasive, chemo-free targeted therapies is opening a new front in the battle against advanced and metastatic breast cancer. By reducing or eliminating frequent hospital visits and the side-effects they earlier took for granted, it is possible to enhance patients' physical and psychological well-being and to help them live longer with dignity and independence.
Breast cancer doesn't mean the end of life. Today, treatment options for breast cancer have advanced, giving hope to patients even in advanced stages. Nowadays, due to government policies (Ayushman Bharat), every woman, regardless of her social strata, can avail of world-class cancer treatment in medical facilities across the country. Even in advanced stages, families should not lose hope, as newer drugs such as molecular therapy treatment have proven effective for patients suffering from hormone-positive breast cancer, which is the most common form of cancer among Indian women. As many as 60 to 90 per cent of patients respond to these advanced treatments positively, enabling them to lead an enhanced quality of life. With such innovations, cancer can be viewed as a chronic disease that needs management.
Awareness-building and sensitisation are key. Educating women and girls in urban and rural contexts about breast cancer, the importance of regular self-monitoring, and de-stigmatising medical examinations and advanced treatment options, so that they can maximise their chances of identifying and beating the disease. It would also help address psychosocial impacts like anxiety, depression, or fear by making therapy or psychiatry facilities accessible, affordable, and un-stigmatised for patients. This would also include teaching families and communities to support patients by accompanying them for treatments, helping with chores, spending time with them, and not letting them feel like a "burden".
The late American writer John Diamond said that cancer is "a word and not a sentence". However, for lakhs of women, breast cancer is a life-changing reality. While conventional treatments for breast cancer are constantly evolving and their efficacy is undeniable, life after a breast cancer diagnosis is about more than survival (extending the patient's life) or pain management (alleviating physical discomfort). What's required is a holistic approach towards improving the quality of the patient's life -- and this is being understood today.
(Padma Shri Pankaj Shah, Medical Oncology Haematology, Zydus Hospital, Ahmedabad)