Advancements in treatment of breast cancer

Healthcare and medicine concept - womans hands holding pink breast cancer awareness ribbon. [Photo: Courtesy]

Advancement in breast cancer treatment over the last five years offers victims a higher chance of survival. With the new developments, women with stage four breast cancer can live up to 10 or 20 years more after diagnosis.

Dr Ahmed Komen, a radiation oncologist at the Aga Khan Hospital, says this has now made the cancer to be considered more like a chronic disease like diabetes and hypertension rather than an absolutely fatal affliction.

“One of the advancements is that initially we were not able to determine which among women with early breast cancer did not require chemotherapy, but with several clinical trial(s) such as one known as the Taylor trial and tests known as the Onco Type DX that is gene testing and the Endopredict, some women do not have to go through chemotherapy, which can have adverse effects,” says Dr Komen.

“For patients with small lumps and they do not have lymph nodes, we do these tests and then look at their score on these tests. Those with lesser scores do not need chemotherapy,” he adds. The medic discloses that newer trials have shown that extensive lymph node removal does not improve survival of the patient. “Sometimes when surgeons remove the glands from under the patient’s armpit, the patient gets arm swelling, and with this new discovery, that can now be avoided,” he says.

The good news is that early breast cancer patients can just get lumpectomy (removal of the lump) and less extensive lymph node biopsy.

On new drugs he says: “The Food and Drug Administration also approved several new drugs between 2017 and 2018 that we are now using to treat advanced breast cancer.”

For women who have a history of breast cancer in the family, the new drug, Olaparib, works for patients with the BRCA1 and BRCA2 gene mutations that predispose them to hereditary breast cancer.

“Treatment of cancer is now moving towards targeted treatment, and before we did not have drugs that could target the genes that cause it, but now it is really helping patients with advanced breast cancer,” says Komen.

The doctor explains that breast cancer is actually a group of diseases, so when testing, apart from samples taken from the lump normally checked under a microscope, a test known as Immunohistochemistry is also done.

“This is molecular testing done to be able to know which group of breast cancer one has, and what drives that particular cancer. Some types of breast cancer are hormonally driven, others are progesterone-receptor driven, others are oestrogen-receptor driven while others are Her2 receptor driven. Each of these have their own medication,” he says.

“However, we now have a group of women that have triple negative breast cancer, meaning the cancer is not driven by any of the receptors. This group usually has no treatment given because they do not respond to any of those treatment, but studies now show that their is hope for them through immunotherapy drugs,” he adds

The advancement in treatment has also led to an improved method of radiation, Intensity-modulated radiation therapy (IMRT), where doctors treat the breast cancer and lymph nodes while sparing normal organs.

Affected parts

“Under the breast there are other organs like the heart and the lungs and we do not want radiation to affect these organs, so with IMRT we are able to spare the organs with no disease,” says Komen. Previously, patients had to undergo mastectomy, removal of the entire affected breast, but now plastic surgeons are able to reconstruct the breast. “The country now has plenty of plastic surgeons who are able to reconstruct their breast and give the patients confidence and improve their quality of life,” he says.

Oncologists agree that there is great awareness on the ground about the reality of breast cancer, thanks to the media, talks on the ground by doctors, and the emergence of many support groups in the country. However, the level of awareness is unfortunately not translating into women going for early screening, according to Komen.

“This is due to lack of financing and proper organisation. Over 80 per cent of the patients come to the hospital when the cancer is already very advanced, either with lumps or when the cancer has actually already become a wound,” he says.

“Many say that the reason they did not come earlier was because of the cost of screening, while others failed to do it because of fear,” he adds. The cost of screening depends on where it is done, but it is roughly around Sh3,500.

Komen says developing a program where women could get free screening would make it more accessible, as currently, less than one percent of women in Kenya go for screening.

Of those who do, it is usually when it is clear that there is a problem,and at that time it is technically not screening that is needed, but rather a biopsy to determine if the lump they have is cancerous.