Breast cancer remains the most common cancer among women in India, constituting 14% of all female cancers. According to Dr Sewanti Limaye, Director, Medical and Precision Oncology, Sir HN Reliance Foundation Hospital, approximately 178,000 new cases and 90,000 deaths were reported in 2020. The incidence of breast cancer is higher in urban areas due to lifestyle factors, and early detection is a major challenge. Many cases are diagnosed at advanced stages, contributing to lower survival rates than in Western countries. Dr Limaye highlights that factors such as limited awareness, late diagnosis and insufficient treatment facilities further exacerbate the problem, and stresses the need for improved detection, public awareness and healthcare infrastructure to reduce mortality rates.
Genetic factors are involved in 5-10% of breast cancer cases, mainly due to mutations in the BRCA1 and BRCA2 genes. Women with these mutations have a significantly increased risk of developing breast cancer. Regular screening methods, including mammograms and clinical breast examinations, are essential, especially for women over 40 years of age or those with a family history of the disease.
Multidisciplinary approach to treatment
In India, breast cancer treatment follows a multidisciplinary approach, explains Dr Limaye. After diagnosis through imaging and biopsy, treatment is tailored based on the stage of the cancer. For early-stage cancers, surgery (either a lumpectomy or mastectomy) is often followed by radiation therapy. More advanced cases may require preoperative treatments such as chemotherapy, targeted therapy, immunotherapy, or hormonal therapy. Postoperative treatment is aimed at preventing recurrence. For triple-negative breast cancer (TNBC), a combination of chemotherapy, immunotherapy, surgery, and radiation therapy is typically used. Treatment plans are highly personalized, taking into account tumor characteristics, the patient's overall health, and the availability of resources. Access to personalized treatments and clinical trials is improving, especially in urban centers.
Side effects and risk of mucositis
Breast cancer treatment can cause a number of side effects, including pain, swelling, hair loss, fatigue, anaemia and, most notably, mucositis. Affecting 15-20% of patients undergoing chemotherapy, mucositis causes inflammation and ulceration of the mucous membranes, especially in the mouth and digestive tract. This can lead to painful sores, making eating difficult and affecting overall nutrition and quality of life. Dr Limaye stresses the importance of monitoring these side effects, as mucositis may require dose adjustments or treatment interruptions in chemotherapy.
Effective treatment of mucositis includes maintaining oral hygiene, pain-relieving measures, and the use of protective mouthwashes. Severe cases may require more intensive interventions.
Treating Mucositis: A Dental Expert's Perspective
Dr. Sacheev Nanda, Senior Dental Surgeon and Prosthodontist at Ruby Hall Clinic, Pune, explains strategies for treating mucositis in cancer patients, which can significantly alleviate symptoms and improve quality of life. He recommends the following key approaches:
- Oral hygieneRegular, gentle oral care with a soft-bristled toothbrush is vital. Rinsing with a saline solution or recommended mouthwash helps keep your mouth clean.
- Pain managementTopical anesthetics such as lidocaine may be prescribed to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help control discomfort.
- NutritionSoft, easy-to-swallow foods should be prioritized. Liquid nutritional supplements may be necessary if solid food intake is difficult.
- HydrationMaintaining hydration is essential and patients should drink plenty of fluids. Saliva substitutes can help combat dry mouth.
- MedicationsCertain medications, such as palifermin, may be prescribed to promote healing of mucosal tissues in at-risk patients.
- Avoid irritantsSpicy, acidic or abrasive foods and drinks should be avoided. Tobacco and alcohol consumption should be discouraged.
- Professional careRegular checkups with a dentist or oral care specialist experienced in treating cancer may be beneficial. In severe cases, speech and swallowing therapy may be necessary.
Supportive therapies
Complementary therapies, such as acupuncture or hypnosis, may provide relief from symptoms. Psychological support can contribute to emotional well-being.
Advances in treatment and care
As of 2024, advances in targeted therapies, immunotherapy, and personalized medicine have significantly improved survival rates and quality of life for patients. According to Dr. Limaye, early detection, combined with innovative treatments, is extending the life expectancy of breast cancer patients. Meanwhile, effective management of side effects, such as mucositis, plays a critical role in reducing the overall burden of treatment and improving patient outcomes.
Both Dr Limaye and Dr Nanda stress the importance of personalised, multidisciplinary care in managing breast cancer and its associated side effects, ensuring that patients receive the best possible treatment and support throughout their journey.
