Dr. Muhammad N. Siddique is one of the most highly qualified Oncologists in Lahore.
Number of Breast cancer screenings has seen a significant rise in Lahore during the last few years – thanks to rigorous awareness campaigns and highly trained Oncologists in Lahore. This has certainly led to a greater proportion of patients diagnosed at an early stage hopefully translating into an enhanced survival of breast cancer patients. However, it seems breast cancer chemoprevention remains relatively unemphasized and ignored even by physicians treating breast cancer on a daily basis. According to a US study, about 15 % of women above the age of 35 years were noted to be eligible for breast cancer chemoprevention. The primary objective of this manuscript is to sensitize the non-oncology health care provider regarding the importance of this valuable treatment strategy. Though a few and far between, those who may qualify for this strategy need to be identified.
What Is Breast Cancer Chemoprevention?
The term refers to a group of medications that work through hormonal manipulation which leads to suppression of breast cancer stem cells growth. Therefore, these drugs attempt to decrease the risk of breast cancer development in high risk individuals.
Who Is A Candidate For This Strategy?
Not every woman should be put on these agents. In fact only a minority of the population would really qualify and not have a prohibitive factor, but the point is those few need to be identified and made aware of the availability of this treatment option. A detailed discussion about patient selection for this strategy is irrelevant for non-oncology physicians, but suffice it is to say that these medications should be considered in women aged 35 years or older who have an increased risk of developing breast cancer. There is no specific cutoff for defining “increased risk,”. Some studies define this as at least a 3% chance of developing breast cancer in the next 5 years, and others advocate for at least 1.7%.
How Is The Breast Cancer Risk Determined?
This risk is determined by considering personal history, family history and reproductive factors, such as the age of menarche. Women may be born with hereditary genetic mutations that put them at very high risk of breast cancer. There are multiple breast cancer risk estimation models that have been developed, none of which is clearly superior to the others. Both the personal risk factors (age, menstrual history, pregnancy history, history of previous breast biopsies) and family history are common components of these risk assessments tools, with some using more extensive family history and mammographic density. Which tool to use and how to interpret results for people in Pakistan should be discussed with a well qualified Medical Oncologist. In developed countries, every decent sized hospital has genetic counselors and they provide consultations in this regard.
What Medications Are Available for Chemoprevention?
The medications that may be used for breast cancer risk reduction include selective estrogen receptor modulators (SERMs), such as tamoxifen and raloxifene, and aromatase inhibitors (AIs), such as anastrozole and exemestane. Although any of these medications may be prescribed for postmenopausal women, tamoxifen is the only option for premenopausal women. The typical treatment duration is 5 years.
Efficacy Of These Medications
These medications may reduce a person’s risk of certain types of breast cancer, but there is no evidence that they decrease the risk of developing estrogen receptor (ER)–negative breast cancer. Women taking these medications should still undergo regular breast cancer screening.
Potential Adverse Effects Of These Medications And How A Medical Oncologist attempts to counter them
Adverse effects of these agents include some sinister disease processes such as Uterine cancer, venous thromboembolism, osteoporosis, stroke, cardiac disease, and metabolic derangements. Therefore, benefits and risk factors should be very carefully weighed for each individual patient by a well qualified Medical Oncologist in order to determine whether or not chemoprevention is indicated, whether the benefit clearly outweighs the risks and which agent provides a better therapeutic index for a given patient. Some other untoward effects e.g vasomotor symptoms, mood swings, arthralgias etc can be managed with supportive medications and lifestyle adjustments under the guidance of a well trained Medical Oncologist.
Steps for Physicians Who Think Their Patient May Benefit From These Medications
Any healthcare workers who believe a patient might benefit from breast cancer risk–reducing medications should refer the patient to a Medical Oncologist or at least discuss the options with them. Fortunately, now there are a few highly trained Oncologists in Lahore as well as in other larger cities of Pakistan. The goal is to determine who is likely to have the greatest benefit from these medications and whether these outweigh the risks. This is a nuanced and personalized decision based on individual history and risk factors, and the evidence for these medications is constantly evolving. Thus, a Medical Oncologist will best be able to help determine if these medications might be beneficial.
About the author: Dr. Muhammad N. Siddique is CEO at ilaj.org. He is one of the few American Board certified Hematologists and Oncologists who are providing cancer care in Pakistan. He is considered one of the top cancer doctors in Lahore as well as in USA. Follow the link for appointments.
Author Disclosure: Dr Muhammad Nauman Siddique is one of the Medical Oncologists in Lahore and thus prescribes hormonal therapy on daily basis. However, he does not receive any financial compensation on any account from any pharmaceuticals.
Disclaimer: If the reader is a patient or non-healthcare entity, please note that the information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. Also note that a medical concept true today can be obsolete tomorrow. For specific information concerning your personal medical condition, the writer suggests that you consult a physician in person. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients.
I regard something genuinely interesting about your weblog so I saved to bookmarks . Kiran
There is definately a lot to find out about this issue. I love all of the points you made. Erin Rigolo
I like the efforts you have put in this, regards for all the great articles. Zara
Wow! Truly helpful facts about an important issue. Steve
If some one needs to be updated with most up-to-date cancer literature they must visit this web page and be up to date everyday. Kausar Sami
Hi colleagues, how is all, and what you would like to say on the topic of this paragraph, in my view its really remarkable for me. Kainaat
This is very beneficial , Thanks for taking your time to write this. Fatima
Excellent article. To the point. Very educating. Definitely many women are unaware about this important info. You need to take part in a contest for one of the best blogs on the web. Ranee.
You made some clear points there. I looked on the internet for the topic and found most guys will consent with your blog. Roshni
very helpful article!