Dr. Alpesh Kikani, Medical Oncologist, Shashwat Haemato-Onco Associates, Rajkot, explains that breast cancer patients diagnosed at an early stage can benefit from a predictive test to better understand the disease and receive individualized treatment.
According to a WHO (World Health Organization) report, 6.85 million people died from breast cancer in the world in 2020. About 1 in 4 cancers in women worldwide is breast cancer. Breast cancer is the most common cancer among women and the leading cause of death.
Breast cancer is diagnosed in India every four minutes and kills every 13 minutes. The incidence of this cancer is highest among Indian women.
Early detection and treatment of breast cancer ensure a high survival rate. In many low- and middle-income countries, including India, nearly 50 percent of breast cancers are diagnosed at an advanced stage (stage 3 or 4). Diseases detected at these stages are more difficult to treat and are usually incurable. Depending on the type, breast cancer can be aggressive or non-aggressive. TNBC (triple negative breast cancer) and HER2+/neu are more aggressive compared to ER+/HER2-/neu breast cancer, which is relatively less aggressive.
When diagnosed at an early stage, patients with ER+/HER2-/neu breast cancer have a favorable prognosis. Most patients with early-stage HR+/HER2- breast cancer do not benefit from chemotherapy, as has been observed and well documented in the literature. Standard hormonal or chemotherapy treatments may not work the same for all patients. The prognosis for each patient receiving standard therapy is different. Generally, clinicians assess patient prognosis based on clinical factors such as tumor size, tumor grade, patient age, number of +ve nodes and Ki-67 status, EMS, PR, etc. Chemotherapy affects both physical and on the mental health of the patient undergoing treatment. Chemotherapy is prescribed for the rapid growth of cancer cells. However, along with cancer cells, it also destroys healthy cells, mainly cells that grow rapidly, causing side effects in patients.
A prognostic test predicts the response to a standard treatment that is prescribed to treat a disease, thus predicting the likelihood that a patient will develop a disease or experience a medical event in the future. Prognostic tests for breast cancer analyze certain biomarkers in the patient’s body, such as specific genes, gene expression patterns, or protein biomarkers that allow us to assess the risk of recurrence. By using a predictive test in breast cancer patients, especially in HR+/HER2- disease, patients could avoid useless and ineffective chemotherapy. Prognostic tests determine which patient will benefit from chemotherapy.
Early detection of breast cancer can spare the patient from aggressive treatments such as chemotherapy, especially in ER+/HER2/neu negative patients, and can lead to a better “quality of life” for the patient.
Breast cancer patients who are diagnosed at an early stage can benefit from a predictive test to better understand the disease and receive individualized treatment. Predictive tests assess the risk of cancer recurrence for individual patients and allow doctors to personalize treatment for each, leading to improved quality of life and improved clinical outcomes.
In some cases, patients may be identified as less likely to have cancer recurrence based on clinical parameters or other prognostic markers, such as Ki67, as assessed by an oncologist, which may not be accurate in determining how the cancer may behave in the future. The advantage of the prognostic test is that it identifies the patient with a higher chance of recurrence based on the characteristics of the cancer, which further helps to optimize the treatment for each patient. This approach ensures that patients are not under- or over-treated and puts patients at risk of future relapses.
According to major international cancer treatment guidelines such as the NCCN (National Comprehensive Cancer Network), prognostic tests are an important part of breast cancer treatment.
Despite the wide range of prognostic tests available, not all of them have proven useful or clinically useful for Indian patients. The Indian version of “CanAssist Breast” has been tested on Indian patients. CanAssist Breast is a predictive test developed by OncoStem Diagnostics that classifies patients as either “low risk” or “high risk” based on the patient’s five-year risk of breast cancer recurrence. Similar tests provide information about the risk of recurrence in patients with hormone receptor-positive early-stage breast cancer. It analyzes important biomarkers in the tumor to assess the risk of recurrence and helps oncologists personalize treatment plans. The test uses a proteomics-based method and an AI-based algorithm to analyze a proprietary combination of protein biomarkers from a patient’s tumor to calculate the risk of cancer recurrence. The result of the test allows breast cancer patients who are classified as “low risk” to potentially avoid chemotherapy and its side effects.
Seeking help with a prognostic test has been shown to provide oncologists with in-depth information about breast cancer, allowing them to make an informed decision and provide better outcomes. On the other hand, patients can safely skip chemotherapy, which will help them lead a normal life after cancer treatment.