Why screening is better than cure in breast cancer

State should prompt women to undertake health check-ups, say doctors

Screening of women aged 40 years and above should be made a norm in the State, which has a fairly high prevalence rate of breast cancer.

According to the population-based registry at the Regional Cancer Centre, Thiruvananthapuram, in 2014, the prevalence rate is 40 per 1,00,000 women population.

Medical professionals believe that the State needs to step in to prompt women for health check-ups. Mammogram can detect tumours that are less that one cm or even less than 0.5 cm.

For women with a family history of the disease, screening is advised at an earlier age.

Oestrogen, the growth hormone of women, essential in the reproductive cycle, plays a major role in feeding the growth of tumours. Having early menarche and late menopause exposes women to the hormone for a longer period of time. If women are exposed to oestrogen for a longer period of time, the risk of cancer increases, says oncology surgeon K. Chithrathara. Child-bearing and breast-feeding are said to reduce the overall exposure to oestrogen in the body.

Since no specific causes have been identified, the best practice is to avoid risks, she adds.

Obesity is a major risk factor as larger bodies expose more cells to oestrogen. Hormone replacement therapies, if clinically needed, should be undertaken only after conducting genetic tests that identify predisposition to breast and ovarian cancer, she says.

The cure rate and the type of treatment depend a lot on the biopsy report that grades the tumour by its size and type.

Medical oncologist K. Pavithran says Stage 1 of breast cancer is seen to have about 95 per cent cure, with only five to 10 per cent chance of recurrence.

Even Stage 4 is curable in certain cases.

Surgery, targeted radiation

Surgery and targeted radiation is recommended as the first line of treatment for Stage 1, Dr. Pavithran adds. Early detection saves the breast and, in most cases, chemotherapy can be avoided in post-menopausal women, he says.

The pathology report, which indicates whether the hormone receptors are positive or negative, will indicate the need for chemotherapy, says Dr. Chithrathara.

If the hormone receptors are positive — which is so in 80 per cent of the cases — surgery can be conducted, followed with medication to block the receptors that will render the oestrogen inactive.

If the hormone receptors are negative, it indicates that the tumour has found a different pathway than the oestrogen receptor.

Such a person will have to take chemotherapy.

If the hormone receptor is positive in pre-menopausal women and they want to avoid chemotherapy, they may choose to surgically remove the ovaries too along with the tumour in the breast, says Dr. Chitrathara. That was what Hollywood actor Angelina Jolie did earlier this year.

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DR Chitrathara K

HOD & Senior Consultant in Surgical & Gynaec Oncology. VPS Lakeshore Kochi
Specialized in gynecological, urological, and breast cancer surgeries.

  • Actively participated in the development of surgical oncology as a separate speciality in Kerala
  •  First lady Urologist of Kerala.
  • Started Kerala's first Gynaecological Cancer Surgery unit at Regional Cancer Centre, Thiruvananthapuram in 1993 & urological oncology in 2009.
  • Authored malayalam book “ Sthreekalile Arbudam-Ariyendathellam” published in 2014 by DC books
  • Editor of the following books - Ovarian Cancer (2008), Cervical cancer (2010) and Uterine Cancer (2015).

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