BREAST CANCER PART-14
Welcome to part 14 of educational series on breast cancer.
Question: Thank you Dr. Chiragbhai. We really appreciate your honest opinion about stage 4 breast cancer. It was interesting to note that there are many subsets of stage 4 cancer and that many patients live for a long period. Also, concept of goal setting, observation only in some patients, use of hormonal therapy primarily, use of single agent chemotherapy, place for targeted therapies and other issues were quite informative and provided good guideline.
Answer: Thank you for summarizing it so well. Please do not forget the importance of proper early therapy, both local and systemic, at first diagnosis, to prevent metastatic disease. Hope the readers will also advise people about advantages of early diagnosis, and of course prevention, the ultimate goal.
Que: Now Dr. Chiragbhai, we have discussed early diagnosis and prevention earlier. But what about secondary prevention i.e. what should a woman do who has completed treatment for breast cancer? What lifestyle, what tests, what follow up?
Ans:.This is a very important question. A woman is very concerned at the end of initial intensive treatment such as chemotherapy, surgery, radiotherapy. Some of them will go on to hormonal therapy, and some will have no more active treatment.
Knowing that there is a chance of relapse, more or less depending upon stage, makes them very anxious. Women want to know what they can do to prevent relapse, or at least make an early diagnosis in case cancer were to come back.
Que: What can they do to prevent relapse?
Ans: Most important step is to take regular treatment if advised, such as hormonal therapy, or in some cases herceptin. Apart from this, it is known that maintaining weight close to their baseline, regular exercise, and reduced dietary fat intake reduce risk of relapse.
Que: What can they do for early diagnosis, in case of relapse?
Ans: This is an area where a lot of unindicated tests are done. Most people think that frequent scans and blood tests will lead to early diagnosis and will make them live longer. Unfortunately this is not true. Only things that help in follow up are: monthly self examination, regular examination by doctor (initially every 3 months and then increasing period), annual mammogram of remaining breast (both if lumpectomy), and early reporting of new persistent symptoms. Later should lead to specific tests e.g. new persistent abdominal pain should be evaluated by related blood tests and sonography or CT scan. Some recommend annual chest x-ray.
It has been studied several times and it is very clear that frequent scans and blood tests, including tumor markers, do not lead to early diagnosis that translates in to prolonging life or saving life. In fact, most of the time it leads to false alarms, leading to unnecessary biopsies or further tests and anxiety. I have seen many such patients. All guidelines also recommend against such tests in asymptomatic follow up patients.
We give a follow up chart to our patients, where one of the lines is “Bone scan, Tumor markers, Ultrasonography, CT scan are not routinely recommended”.
I would like to thank readers at this point for providing me enough inspiration to continue to write. And if there are no questions by next issue, we would close series on breast cancer. Next topic series will start with next issue. Suggestions for topic are welcome.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA),
Diplomate American Board of Oncology and Hematology.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. 079 26754001 www.shyamhemoncclinic.com