What You Should Know About Breast Cancer Treatment

Advances in medical science mean that breast cancer treatment today has good outcomes for many patients, especially if detected early. Learn about the options available today to breast cancer patients.

October is Breast Cancer Awareness Month. In an effort to raise awareness about breast cancer, and clarify the many doubts and misconceptions all of us have, Women’s Web presents a series of interviews with medical professionals all through October.

In the first two interviews in this series, we discussed why it is important to do self-exams and get tested for breast cancer early, as well as what you should know about mammograms, one of the most effective ways to detect breast cancer.

In this interview, he talks about different treatment options for breast cancer, and what patients and family members need to know while evaluating them.

How do you advise patients on the different options for breast cancer treatment? What are the different factors that you consider?

Dr. Nilesh Lokeshwar: For breast cancer, the treatment usually involves a combination of surgery, chemotherapy, hormone therapy, radiation therapy, and targeted therapy. Modern treatment of breast cancer is a multimodality approach that includes local treatment (surgery and radiotherapy), and systemic treatment that includes chemotherapy, hormonal therapy and targeted therapy.

Factors that help decide the different options and sequence include:

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• Age of the patient and co-morbidities (diabetes, cardiac disease)
• Stage of the disease – tumor size and lymph nodal involvement
• Menopausal status – pre or post menopausal
• Grade of the disease – low grade (I) or high grade (III)
• Hormone receptor status (estrogen and progesterone receptor and Cerb B2 receptor status.)
• Individual choice (mastectomy Vs breast conservation)

Is local therapy an adequate treatment on its own or does it always have to be in conjunction with systemic therapy?

Dr. Nilesh Lokeshwar: In most cases it is a combination of local therapy along with systemic therapy including chemotherapy and hormone therapy. Systemic therapy may sometimes be avoided in patients who are elderly, have low grade disease (grade I) and a small tumour size, i.e. lesser than 1 cms.

What are the different factors that patients and family members need to consider before choosing a treatment option?

Dr. Nilesh Lokeshwar: These days, most oncologists and institutions follow international recommendations for guidelines (NCCN, ASCO) and therefore treatment is standardized for chemotherapy (common regimens used). There may be variations in the choice of drugs used after considering age, tolerance issues, co morbidities and costs. There are treatment regimens that can be tailored to a budget.

For surgery in early cases (stage I, II) the patient may be offered breast conservation which includes removal of the lump and the axillary tissue (along with radiotherapy) and keeping the breast intact. This approach is proven to be equal to radical modified mastectomy and is the standard of care in most countries. It prevents a mutilating mastectomy and helps improve body image and confidence, and thus makes rehabilitation easier.

Can breast cancer survivors go on to have children? Do they have to take any precautions to preserve fertility? Are there any treatments that they must not undergo if they are to retain fertility?

Dr. Nilesh Lokeshwar: Some breast cancer survivors do go on to have children. This is especially in patients who are younger and who do not receive hormone therapy (which needs to be given for 5 years in patients whose tumors express ER and PR receptors and may have a contraceptive effect).

Chemotherapy can cause cessation of menses temporarily. Most younger patients (< 40 years) will resume their menses within a year.

Can breast cancer treatments trigger menopause?

Dr. Nilesh Lokeshwar: Chemotherapy can induce menopause in patients with breast cancer. It may be temporary and may resume in a few years in younger patients. In patients older than 45 years it may trigger permanent menopause. This cannot be avoided.

Studies have clearly shown that induction of menopause is suggestive of good prognosis. This is because breast cancer is a hormone (estrogen) dependent and driven cancer.

What are the typical side effects that can be expected during treatment? Do all treatments have side effects like hair loss, fatigue, and nausea?

Dr. Nilesh Lokeshwar: Typical side effects of chemotherapy include:

• Hair loss, nail and skin changes,
• Nausea and vomiting,
• Weakness, anorexia and loss of taste
• Mucositis (mouth ulcers)
• Diarrhea (loose motions)
• Decrease in blood counts and susceptibility to infections.

These are common side effects and in most patients are mild. In fact, with presently available medicines, most are avoidable or easily treated. Hair loss, however, occurs uniformly in most patients who undergo chemotherapy for breast cancer. Some centers in the West use scalp cooling devices which decreases the extent of hair loss. These machines are not yet commonly used in our country.

How much does treatment typically cost? How important are financial considerations in deciding treatment options? Are there any avenues open for women who cannot afford expensive treatment?

Dr. Nilesh Lokeshwar: Most chemotherapy regimens cost between Rs 5000/- to Rs 30000/- per cycle depending of the choice of drug, weight and height, generic vs original molecule (most Indian generics are excellent and there is no obvious difference), choice of hospital and ward (daycare vs. private room)

Patients who cannot afford expensive treatment can consider:

• Cheaper generics and drug regimens without compromising on efficacy,
• Treatment thru Rajiv Gandhi scheme available in some hospitals,
• Assistance through various trusts that help if the patient has a genuine financial problem.

If you notice any lumps or suspicious changes on your breasts, get in touch with a medical professional immediately. Dr. Lokeshwar can be contacted at [email protected]

Breast cancer awareness image via Shutterstock

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