Breast Cancer Management Amidst Pandemic: What Expert Has To Say

According to a recent report released by Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics & Research (NCDIR), breast cancer will be the most common cancer among women in India (estimated 2 lakhs) in 2020. Breast cancer is on the rise even among women in their early 30s owing to sedentary lifestyles, genetics, dietary changes and family history of cancer. Breast cancer originates in the breast tissue when cells start growing abnormally and stop functioning like normal cells. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast or spread to other parts of the body, when left untreated.

Symptoms of breast cancer

• A lump in the breast or underarm that persists after your menstrual cycle - this is often the first apparent symptom of breast cancer. Lumps associated with breast cancer are usually painless, although some may cause a prickly sensation.
• Although lumps are usually painless, tenderness or pain can be a sign of breast cancer
• A noticeable flattening or indentation on the breast, which may indicate a tumour that cannot be seen or felt
• Unusual discharge from the nipple that may be clear, bloody, or of another colour
• Redness or rashes around the nipple
• Swelling around the collarbone and armpit

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Treating breast cancer

Treatment for breast cancer depends on the stage of cancer. Even though breast cancer is considered to be non-invasive at a nascent stage, it requires immediate intervention for preventing the disease from progressing to a malignant stage. The most common types of treatment are surgery, chemotherapy, radiation therapy, hormone therapy, and immunotherapy.

Different types of breast cancer surgeries are performed for different reasons such as removal of a tumour, restoration of the breast's shape post-surgery, relieving symptoms of advanced cancer and assessing if cancer has spread to the lymph nodes under the arm. The most common surgeries are mastectomy and lumpectomy. Mastectomy involves removal of the entire breast for removing a cancerous tumour while Lumpectomy, also referred to as breast conservation surgery (BCS), involves removal of the cancerous portion of the breast and an area of normal tissues surrounding cancer.

Understanding Breast Conservation Surgery

BCS involves the removal of only the cancerous tumour and helps strike a balance between maintaining the shape and safety of the breast. Removal of the breast like in the case of mastectomy leads to a flat chest which can be the cause of low self-esteem among women. Although there are plastic surgical procedures available to create a new breast, it may not be a feasible option due to the complications involved. Moreover, studies have shown that if BCS is conducted during the early stages of the disease, the rate of survival or recurrence is comparable to that of a mastectomy. The patient must consider two important parameters before opting for this surgery- the size of the tumour and the number of tumours in the same breast. The advancement of surgical procedures has made it possible to use BCS as a treatment option even for large tumors. Early detection and screening also plays a key role as it helps prevent patients from undergoing an extensive surgery as in case of more advanced cases.

Oncoplastic Surgery: The BCS should not leave the patient with a deformed breast and this is where oncoplastic surgery can help in restoring the normal cosmesis of the breast by mobilising the remaining breast tissue to fill the gap created by the removal of the cancerous tumour. This also allows for larger lumps to be removed without compromising on the safety of the procedure.

Sentinel Lymph Node Biopsy: This is a reliable and safe technique used for detecting the spread of the cancer to the lymph nodes without the need for removing all of them as in the usual case. The disease status of the lymph nodes is the most important determinant of patient outcomes in the early stages of breast cancer.

Adjuvant Radiotherapy: Post conducting a BCS, it is imperative to administer radiotherapy to the remaining breast to reduce chances of recurrence. This procedure is administered over a period of 5 weeks.

Breast cancer treatment amidst the pandemic

Early detection is crucial for all cancers, especially for breast cancer to minimise treatment in the form of surgery or chemotherapy. Patients may have been delaying their diagnosis even on observing symptoms or changes in their breast due to fear of the COVID-19 virus. This has resulted in an increasing trend of breast cancer being detected at an advanced stage worldwide. In India, where 80% of patients present in late stages, delaying it further can lead to serious consequences. Hence, diagnosis and detection of breast cancer should not be avoided or delayed by patients amidst the pandemic and must be prioritised. While patients undergoing cancer therapy might face some complications since their immunity is weakened, hospitals and doctors are taking precautions to ensure that they are safe and get the treatment they require.

(Dr Kanchan Kaur, Director Breast Services, Cancer Institute at Medanta Hospital)

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