Advances in Breast Cancer Treatment and General Masses in Developing Countries

Afzal Anees
Department Of Surgery, JN Medical College, Aligarh Muslim University, India
*Mohammad Saleem
Department Of Applied Mathematics, Faculty Of Engineering, Aligarh Muslim University, Aligarh, India
Yashawanth TM
Department Of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, India

*Corresponding Author:
Mohammad Saleem
Department Of Applied Mathematics, Faculty Of Engineering, Aligarh Muslim University, Aligarh, India
Email:saleemmd60@gmail.com

Published on: 2020-12-18

Abstract

Breast cancer is the most common malignancy in women and a major public health concern worldwide. Breast cancer at present has surpassed carcinoma cervix, ovarian and uterine tumors in developing countries [1]. The incidence as well as cancer-related deaths are increasing globally. In 2018, 2.1 million new cases were diagnosed, and 0.627 million patients are estimated to die worldwide [1]. This respectively corresponds to 11.6% newly diagnosed cancers and 6.6% deaths of all cancers [2]. The estimated number of incidences of breast cancer in India in 2016 was 0.118 million [3]. Breast cancer incidence rate is increasing in developing countries due to changes in lifestyle, alcohol consumption, sedentary activities, dietary habits (saturated fat), obesity, exposure to ionizing radiation, hormone replacement therapy (HRT), and delay in childbearing. It is involving the large female population irrespective of age, parity, socioeconomic status, and other risk factors [4]. Hereditary and genetic factors account for 5 - 10% of breast cancer [5]. Sporadic breast carcinoma is also in increasing trend as compared to familial cancer. Breast cancer developed at a younger age is more aggressive, poorly differentiated, and more likely to metastasize. Younger-age patients tend to be triple-negative (ER, PR, HER 2 NEU negative) and the prevalence of triple-negative breast cancer in India is considerably higher compared with that seen in western countries [6].

Keywords

Breast Cancer, Women, Radiotherapy

Short Commentary

Breast cancer is the most common malignancy in women and a major public health concern worldwide. Breast cancer at present has surpassed carcinoma cervix, ovarian and uterine tumors in developing countries [1]. The incidence as well as cancer-related deaths are increasing globally.In 2018, 2.1 million new cases were diagnosed, and 0.627 million patients are estimated to die worldwide [1]. This respectively corresponds to 11.6% newly diagnosed cancers and 6.6% deaths of all cancers [2]. The estimated number of incidences of breast cancer in India in 2016 was 0.118 million [3]. Breast cancer incidence rate is increasing in developing countries due to changes in lifestyle, alcohol consumption, sedentary activities, dietary habits (saturated fat), obesity, exposure to ionizing radiation, hormone replacement therapy (HRT), and delay in childbearing. It is involving the large female population irrespective of age, parity, socioeconomic status, and other risk factors [4]. Hereditary and genetic factors account for 5 - 10% of breast cancer [5].Sporadic breast carcinoma is also in increasing trend as compared to familial cancer. Breast cancer developed at a younger age is more aggressive, poorly differentiated, and more likely to metastasize. Younger-age patients tend to be triple-negative (ER, PR, HER 2 NEU negative) and the prevalence of triple-negative breast cancer in India is considerably higher compared with that seen in western countries [6].

Mammography is still a cost-effective tool for screening breast cancer. Since the last decade, we can see the advancement in breast imaging like MRI, elastography, PET scan, and stereotactic localization. Further, there is advancement at the molecular level in the form of tumor markers, immunohistochemistry, and genetic mapping. The tumor markers CEA and CA 15.3 are currently used in clinical practice for monitoring therapy [7]. The treatment of breast cancer is showing a paradigm shift from more radical to less invasive [8].In this scenario, breast conservation surgery is showing encouraging results with the support of newer adjuvant therapy. Reconstruction surgery is also being opted for by many [8, 9]. The recent data is showing better tolerability and response rate with the taxane-based chemotherapy [10, 11]. The newer trends in radiotherapy are also presenting a better response with lesser complications [12]. Recently, advancement in hormonal and immunotherapy has been noticed with a better disease-free survival rate [13]. Although much advancement has taken place in the treatment of breast cancer the crux of successful treatment still depends on its early diagnosis. Studies have reported a better disease-free survival rate when the intervention is in the early stage of breast carcinoma [14].

In developing nations like India, it is difficult to make an early diagnosis.As we know, a high percentage of the female population in developing countries is uneducated, living with social inhibitions, ignorant, and unaware of the disease and its advancements. At the same time, in most developing countries better health facilities, screening, counselling, and awareness are lacking at a semi-urban and rural level due to the non-availability of desired funds. Thus, the problem needs to be tackled by the multi-approach active participation of public, health care providers, and state and non-state funding agencies. More specifically, the advancement in breast cancer and its benefits to the population should go side by side.

In the present era of advancement, the responsibility of the health care providers has increased.The main concerns are lack of health facilities, lack of awareness, absence of screening programs, and un-affordability by the general population. Implementing policies effectively dealing with these issues will certainly reduce morbidity and mortality and the fruits of the advancement in breast cancer can reach the masses [15].

Conflict of Interests Statement

The author declares no conflict or competing interest with respect to the authorship and publication of this article. The author has no financial relationship with any organization.

Disclosure of Funding Support

This manuscript did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA et al. (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer J Clin 68:394-424.https://doi.org/10.3322/caac.21492
  2. Solikhah S, Nurdjannah S (2020) Assessment of the risk of developing breast cancer using the Gail model in Asian females: A systematic review. Heliyon 6:e03794.https://doi.org/10.1016/j.heliyon.2020.e03794
  3. Dhillon PK, Mathur P, Nandakumar A, Fitzmaurice C, Kumar GA, et al. (2018) The burden of cancers and their variations across the states of India: The Global Burden of Disease Study 1990–2016. Lancet Oncol 19:1289-306.
  4. Mathew A, George PS, KM JK, Vasudevan D, James FV (2019) Transition of cancer in populations in India. Cancer Epidemiol 58:111-20.https://doi.org/10.1016/j.canep.2018.12.003
  5. Valencia OM, Samuel SE, Viscusi RK, Riall TS, Neumayer LA, et al. (2017) The role of genetic testing in patients with breast cancer: a review. JAMA Surg152:589-94.https://doi.org/10.1001/jamasurg.2017.0552
  6. Malvia S, Bagadi SA, Dubey US, Saxena S (2017) Epidemiology of breast cancer in Indian women. Asia?Pac JClin Oncol 13:289-95.https://doi.org/10.1111/ajco.12661
  7. Moazzezy N, Farahany TZ, Oloomi M, Bouzari S (2014) Relationship between preoperative serum CA15-3 and CEA levels and clinicopathological parameters in breast cancer. Asian Pac J Cancer Prev 15:1685-8.https://doi.org/10.7314/apjcp.2014.15.4.1685
  8. Marinovich ML, Noguchi N, Morrow M, Houssami N (2020) Changes in reoperation after publication of consensus guidelines on margins for breast-conserving surgery: a systematic review and meta-analysis. JAMA Surg 155: e203025.https://doi.org/10.1001/jamasurg.2020.3025
  9. Lee GK, Sheckter CC (2018) Breast reconstruction following breast cancer treatment-2018. JAMA 320:1277-8.https://pubmed.ncbi.nlm.nih.gov/30178060/
  10. Bignon L, Fricker JP, Nogues C, Mouret?Fourme E, Stoppa?Lyonnet D, et al. (2018) Efficacy of anthracycline/taxane?based neo?adjuvant chemotherapy on triple?negative breast cancer in BRCA 1/BRCA 2 mutation carriers.Breast J24:269-77.https://doi.org/10.1111/tbj.12887
  11. Vetter M, Fokas S, Biskup E, Schmid T, Schwab F, et al. (2017) Efficacy of adjuvant chemotherapy with carboplatin for early triple negative breast cancer: a single center experience. Oncotarget 8:75617.https://doi.org/10.18632/oncotarget.18118
  12. Schäfer R, Strnad V, Polgár C, Uter W, Hildebrandt G, et al. (2018) Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial. Lancet Oncol 19:834-44.
  13. Cameron D, Piccart-Gebhart MJ, Gelber RD, Procter M, Goldhirsch A (2017) 11 years follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin Adjuvant (HERA) trial.Lancet 389:1195-205.https://pubmed.ncbi.nlm.nih.gov/28215665/
  14. Chetlen A, Mack J, Chan T (2016) Breast cancer screening controversies: who, when, why, and how? Clin Imaging 40:279-82.https://doi.org/10.1016/j.clinimag.2015.05.017
  15. Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, et al. (2015) Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA 314:1599-614.https://doi.org/10.1001/jama.2015.12783
scroll up