This interview was originally published in www.oncofocus.com on 17th October 2019
Cancer awareness is a continuous exercise that requires a multi-dimensional approach and the proactive involvement of every stakeholder. Oncofocus, is a management consulting and research firm, will be publishing every month a short interview with leading Oncologists across the APAC region on a particular Cancer type. The main objective of these interviews is to learn the "What, Why, How" of the present state of cancer management directly from the treaters.
October is Breast Cancer Awareness Month, we have dedicated our next two posts in our Cancer Interview series on Breast Cancer Awareness. Our analyst Ms. Shilna Kunnath connected with Dr. Bhaumik Shah, Consultant Medical Oncologist from Aurora Specialists Care, Melbourne, Australia, and discussed the basics of breast cancer from the perspective of Australia.
Dr. Bhaumik Shah
MBBS, MD, FRACP (Medical Oncology)
Aurora Specialists Care, Melbourne, Australia
In Australia, there is a nationalized screening of breast cancer... everybody above the age of 50 gets a free mammogram...there is a 95% cure rate in breast cancer, as it is detected in early stages
We understand that most cancers are manageable if they are identified at an early stage. So, for someone to get an early diagnosis, are there any early signs and symptoms to look for breast cancer?
Dr. Shah: For breast cancer, there are a few things that are essential and should be taken care of. Like, the normal appearance and feel of their breasts, as in women before menopause. The consistency and feel of the breast changes with different phases of the menstrual cycle, and they should know what’s normal for them. If there is anything different, in terms of appearance, like wrinkling of skin or puckering or any discoloration or they feel any lumps, any unusual discharge from nipples, or any unbearable pain, it is essential to report to the doctor and get it checked.
Breast cancer has two incidence peaks. They have a peak at an early age, as well. Even women between 30-50 can have breast cancer as well. So, it is crucial to keep in mind breast cancer is not a disease only in elderly women but also occurs in mid-age women as well.
What are your suggestions to increase the early diagnosis of breast cancer?
Dr. Shah: Women should do a self-examination of their breasts while taking a shower or by looking in the mirror. This exercise can be performed once a month to check for any lumps, discharge, or discoloration. This method is the simplest but very effective way of knowing that something is different or changed.
Who are at risk of developing breast cancer?
Dr. Shah: Anybody can get breast cancer. There are certain risk factors related to family history and lifestyle choices. So, in terms of risk factors related to family history, around 10% of breast cancer can happen due to genetic factors running in the family.
Most cancers can be linked by the same gene abnormality, as they are carried by a first-degree relative (mother, sister, or daughter). So, anybody, who has a first-degree relative with breast and ovarian cancer, should be more mindful because they are at a higher risk.
The second type of risk factor is related to biology and lifestyle choices. Women who have early menarche or have delayed menopause have high hormonal exposures, and certain breast cancers can develop more often in them. Obesity can also increase the risk of breast cancer. Smoking and alcohol also, to a certain extent, increase the risk of breast cancer.
The third risk factor would be prolonged use of hormonal agents -
in the form of contraceptive pills for five years before the age of menopause,
it can be hormone replacement therapy for two years after menopause.
Unintentional exposure to radiation for the treatment of any other cancer can also play a risk factor in the development of breast cancer.
So, doctor when we say or talk about breast cancer, it's generally more in females. We also know that there is breast cancer in males as well. Can you tell me more about it and any other type of breast cancer?
Dr. Shah: We always believe that breast is something women have. I think it is essential to know that men also have breast buds or breast tissue, which doesn’t develop as much in women. So, they do not have adequately developed breasts, but we should be aware that there are male breast cancers as well.
Other types of breast cancer can be broadly divided into two types: Hormone Receptor-positive (HR+ve) and Hormone Receptor-negative (HR-ve). Three-quarters of breast cancer would be HR+ve cancers; one quarter would be HR-ve cancers.
Also, there is one more sub-type based on the presence of receptors for HER2. It is called HER2+ve and HER2-ve.
There is a subset of breast cancer, which is both HR-ve and HER2-ve, and they are in a way called Triple-negative Breast Cancers (TNBC).
Currently, in Australia, the majority of them are HR+ve and HER2-ve cancers. But I would say the most alarming or most aggressive kind of breast cancer is Triple-negative Breast Cancer, where both hormone receptors and HER2 receptors are negative.
The distribution of breast cancer is pretty much similar. The risk of breast cancer is not that different in a Caucasian or an Asian. In terms of hereditary breast cancer, it is more common in certain types of Jewish populations.
What is the prognosis? What are the common treatment options?
Dr. Shah: In terms of treatment options, there are three major kinds of treatments available,
Surgery for removal of breast tumor
Radiation to make sure that it does not occur again and
Various kinds of medication, like Chemotherapy and Anti-hormonal treatment.
Another method of treating breast cancer is the use of some biological agents targeting the HER2 receptor.
People who are diagnosed with HR+ve cancer at an early stage, do not require to undergo chemotherapy, they can take anti-hormonal tablets, which are easy to manage and tolerate.
Do you foresee any interesting trends in terms of breast cancer space?
Dr. Shah: In Australia, there is a nationalized screening of breast cancer. So, everybody above the age of 50 gets a free mammogram done once every two years to check for any early signs of breast cancer. These centers are government-funded, which provide treatment and palliative care for free. Hence, there is a 95% cure rate in breast cancer, as it is detected in the early stages.
In terms of treatment, there are some newer agents which belong to the class of drugs called CDK4/6 inhibitors that are used for the treatment of advanced breast cancer.
Also, there is ongoing research in immunotherapy for TNBC, which I mentioned is the most aggressive cancer. It is in the pipeline, where researchers are working on some agents which will stimulate our immune system to attack cancer. This is also an exciting avenue of treatment that might be integrated into the standard treatment in the future for the patient suffering from TNBC.
Doctor, would you like to give a message to any women who are in their early 20s or early 30s on what they can do for awareness?
Dr. Shah: One important takeaway message is that breast cancer is a highly treatable cancer, and with regular screening, it can be cured.
Another thing I would like to suggest is to perform regular self-examination of their breasts to check for any symptoms of breast cancer. Do not hesitate to visit a doctor, if you feel or sense any unusual changes in the breast rather than delaying it.
It could be lifesaving if we can diagnose breast cancer at an early stage as a cure is still a possibility in this stage.