Prognostic tests and their impact on breast cancer treatment

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Dr Aditi Thanky, consultant medical oncologist and Hematologist at Sterling Hospital in Rajkot talks about breast cancer treatment and the role of prognostic testing

According to a report published by the WHO (World Health Organization), in 2020, 2.3 million women were diagnosed with breast cancer and 685,000 deaths worldwide. By the end of 2020, 7.8 million living women had been diagnosed with breast cancer in the past 5 years, making it the most common cancer in the world. Breast cancer is the most diagnosed cancer in women worldwide, accounting for 1 in 4 cancer cases. It is the most common cancer in both sexes and the leading cause of cancer death in women. In India, a woman is diagnosed with breast cancer every 4 minutes and a woman dies of breast cancer every 13 minutes, making it the most common cancer in Indian women.

Survival rates for breast cancer are very high when cancer is caught early and when treatment is available. Unfortunately, nearly 50% of breast cancer cases are diagnosed at an advanced stage (stage 3 and 4) in many low- and middle-income countries, such as India. The disease diagnosed at these stages is more difficult to treat and is usually incurable. The aggressiveness of breast cancer also depends on its type. TNBC (Triple Negative Breast Cancer) and HER2neu + are more aggressive than ER + / HER2neu- breast cancer which is relatively less aggressive.

Patients with ER + / HER2neu- breast cancer, if diagnosed at an early stage, have a good prognosis leading to a high survival rate. It has been observed and well documented in the literature that the majority of patients with early stage HR + / HER2neu- breast cancer have no benefit from chemotherapy. Not all patients respond the same to standard hormone therapy or chemotherapy. The prognosis of each patient with standard treatment is different. Typically, clinicians assess the prognosis of patients based on clinical factors such as tumor size, tumor grade, patient age, number. lymph nodes positive and status Ki-67, ER, PR, etc. Chemotherapy has a negative impact on the physical and mental health of patients undergoing treatment. It is primarily designed to target rapidly growing cancer cells. However, it also destroys healthy cells as it evolves, causing other debilitating side effects in patients.

Based on the risk factors mentioned above, patients are prescribed chemotherapy along with endocrine therapy. But these conventional clinical prognostic markers do not individually examine the disease holistically and therefore lack insight into how each patient responds to treatment more precisely.

What is a prognostic test?

A prognostic test predicts overall results after receiving standard therapy to treat breast cancer. They are different from diagnostic tests, which diagnose specific diseases and conditions. The difference between the two is that while a prognosis can be a guess as to the outcome of treatment or the occurrence of a medical event, a diagnosis actually identifies the problem and gives it a name. Prognostic tests predict a patient’s likelihood of developing disease recurrence or having a future medical event. Prognostic tests look for certain biomarkers in a patient’s body. Biomarkers are natural products in your body, such as antibodies, specific genes, gene expression patterns, or other biomarkers that can identify a particular disease or physiological process in an individual. Examples of biomarkers include everything from blood pressure and heart rate to basic metabolic studies and x-ray results to complex histological and genetic tests of blood and other tissues.

Early detection of breast cancer can save a patient from aggressive treatments such as chemotherapy, especially in ER + / HER2neu negative patients, and can lead to a better “quality of life” for the patient.

Patients diagnosed at an early stage may benefit from prognostic testing to determine the clinical outcome of disease and treatment. Prognostic tests assess the risk of cancer recurrence for each patient and allow doctors to tailor treatment for each individual, resulting in better quality of life and better clinical outcomes.

In some cases, patients may be identified as having a lower risk of cancer relapse based on clinical parameters or other prognostic markers such as Ki67, as judged by the clinician, which may not be precise about the future behavior of the patient. Cancer. The merit of the prognostic test is that it identifies the patient with higher risk of relapse based on the relevant characteristics of the cancer, which helps to optimize treatment for each patient. This ensures that the patient is not undertreated and saves the patient the risk of future cancer recurrences.

The importance of prognostic tests is evident from the fact that they are an essential part of breast cancer treatment as they are part of the main international cancer treatment guidelines such as the National Comprehensive Cancer Network (NCCN).

There are many prognostic tests available, but not all tests have proven their clinical utility and usefulness in Indian patients. The only prognostic test that has been developed and validated on Indian patients is the CanAssist breast test.

Breast cancer has a tremendous physical and emotional impact on a patient’s health. Taking the help of a prognostic test to determine the most suitable treatment option for a patient can bring us closer to a better and happy life for the patient who suffers from it.


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