Managing breast cancer in young women: A survey on challenges and real world scenario
TL;DR
Oncologists were of the view that screening healthy individuals who are at high risk could reduce the incidence of BC in young women of India and practices that are more sensitive to biological, physiological, and psycho-social issues of patients should be followed to improve the survival and quality of life of YBC patients.
Abstract
Breast cancer (BC) is the most common cancer affecting women globally and is the leading cause of cancer death in 103 countries, including India. Recent studies have shown an upsurge in the incidence of breast BC in young Indian women. It is marked by aggressive histological grade, unfavorable hormone status, and higher death rate. The entire process of screening and treatment of young breast cancer (YBC) patients differs from that of postmenopausal BC patients. Relevant issues like fertility preservation, body image reconstruction, and many other psycho-social issues have to be kept in mind while treating YBC so that the quality of life is maintained post-treatment. Cancer in young women is devastating, as they are working either as breadwinners or homemakers supporting their families. The implications are massive as it shatters them financially, socially, and physically. Though Odisha is a large state with a population of 46.446 million, the Population-based Cancer Registry was established in 2022. So, in the absence of properly compiled data, the oncologists' perceptions can help to comprehend the complete picture of the clinical presentation of BC and the challenges in management in the state of Odisha. An online questionnaire was given to 40 Oncologists prctising in the state of Odisha, India. The questionnaire had five aspects: first, the demographic status of the respondents; second, the screening, treatment, and planning strategy; third, post-operative issues; fourth, psycho- social issues; and the last part was the recommendation by the oncologists to improve the status of premenopausal women suffering from BC. The questionnaire survey considered 30-45 years as the age group of young women BC patients. About 68% oncologists confirmed that breast was the most common type of cancer seen in young Indian women, and the maximum number of young women were in American Joint Committee on Cancer (AJCC) stage 2 at the time of diagnosis. Late marriage and nulliparity were the most common risk factors associated with BC in young women. Surprisingly, only 10-30% patients opt for Breast Conservation Surgery (BCS), and 30-60% patients are given Neo-adjuvant chemotherapy. MRI (Magnetic Resonance Imaging) is the most preferred imaging for YBC patients. Most of the doctors recommend gene testing only when the disease is familial. Only 36.4% oncologists said that they always recommend fertility preservation for YBC patients, and egg and embryo freezing was the most preferred method. Early menopause was the most common adverse effect seen post-treatment. The most common psychosocial issue that they observed in young patients was fear of disease recurrence, followed by depression due to a changed body image. Oncologists were of the view that screening healthy individuals who are at high risk could reduce the incidence of BC in young women of India. Despite the widespread availability of modern methods of diagnosis and treatment for BC, YBC patients are treated in the traditional way in the majority of cases. It is necessary that practices that are more sensitive to biological, physiological, and psycho-social issues of patients should be followed, which would ultimately improve the survival and quality of life of YBC patients. Further, the treatment should be more patient-centric, and more emphasis should be given on screening and awareness programs to reduce the early onset of the disease.