Breast cancer is the most common cancer affecting women in India, with as many as 1.7 lakh new patients diagnosed every year. Nearly half of them—around 80,000 women—succumb to the disease annually, a rate significantly higher than in Western countries.
While effective treatment options are available in India, survival outcomes remain poor. Understanding the reasons behind this is critical. This article aims to demystify breast cancer and its treatment options.
Doctors now have a solid understanding of breast cancer biology at the cellular and molecular levels. While the disease is increasingly complex, current knowledge enables effective treatment strategies that yield favorable results for most patients.
How Do Cells Grow in Breast Cancer?
Breast cancer develops from uncontrolled growth of abnormal cells that form a tumor. This can result from gene mutations (e.g., BRCA1/BRCA2), random DNA changes, or other contributing factors.
Sometimes, cancer cells require external triggers to grow, such as certain chemicals or hormones. Key growth stimulants include:
- Estrogen and Progesterone: Naturally occurring hormones that can fuel cancer growth in hormone-sensitive tumors.
- HER2/neu protein: When overexpressed, it promotes aggressive cancer cell growth.
Tumors are tested for hormone receptors (ER/PR) and HER2 status. If a tumor lacks all three—ER, PR, and HER2—it is classified as triple-negative breast cancer (TNBC).
How is Breast Cancer Treated?
Treatment is multimodal and depends on cancer stage and biological features. Options include surgery, radiotherapy, chemotherapy, hormone therapy, and targeted therapy.
Surgery for Breast Cancer
Surgical options depend on tumor size, location, and stage:
- Lumpectomy / Wide Local Excision: Breast-conserving surgeries that remove the tumor and a margin of healthy tissue.
- Mastectomy: Complete removal of the breast and often nearby lymph nodes.
Lymph node dissection in the axilla may be performed based on disease extent. In advanced cases, neoadjuvant chemotherapy may be given before surgery to shrink the tumor.
What Tests Are Done After Breast Cancer Surgery?
Post-surgery, the tumor is analyzed for:
- Cancer type and lymph node involvement (for staging).
- Molecular features via Immunohistochemistry (IHC) to detect ER, PR, and HER2 status.
Additional tests include blood counts, liver/kidney function, echocardiography (for heart function), and others to guide further treatment.
What is Chemotherapy?
Chemotherapy uses drugs to kill rapidly dividing cancer cells. As these drugs circulate in the bloodstream, they reach cancer cells throughout the body.
Since they also affect other fast-dividing cells, side effects may include:
- Hair loss (hair follicles)
- Nausea, vomiting, diarrhea (gut cells)
- Anemia and low white blood cell count (bone marrow)
Regimens vary (4–12 cycles every 1–3 weeks) based on stage, age, and comorbidities.
What is Hormone Therapy?
For hormone receptor-positive cancers, drugs block estrogen or progesterone from binding to cancer cells, preventing tumor growth.
These medications are typically taken for 5–10 years to reduce recurrence risk.
What is Targeted Therapy?
For HER2-positive cancers, drugs like Trastuzumab target the HER2 protein, inhibiting cancer cell growth.
Administered via injection weekly or every three weeks for one year (or until progression), these drugs specifically attack cancer cells with minimal damage to healthy tissue.
What is Triple Negative Breast Cancer?
In 10–15% of cases, tumors lack ER, PR, and HER2 receptors. These TNBCs are aggressive and prone to early recurrence or metastasis.
Since there are no known molecular targets, hormone or targeted therapies are ineffective. Chemotherapy remains the primary treatment option.
What is Radiotherapy or Radiation Treatment?
Radiation uses high-energy X-rays, electrons, or protons to destroy cancer cells near the tumor site.
It is typically recommended after breast-conserving surgery (lumpectomy). Sometimes, radiation is also given to the axilla if lymph nodes are involved.
In advanced stages, radiation can relieve symptoms when cancer spreads to bones or the brain, or be used aggressively for limited metastases in liver, lungs, or brain.
Take Home Messages
- Breast cancer should be managed by a multidisciplinary team: surgical, medical, and radiation oncologists.
- Treatment is personalized and may include surgery, chemotherapy, radiotherapy, hormone therapy, and targeted therapy.
- IHC testing post-surgery is crucial for planning further treatment.
- Breast cancer is curable if diagnosed early and treated fully. Never skip or delay treatment—partial treatment is as ineffective as no treatment.