A five-year international study has now affirmed that certain treatment regimes are more effective in putting a brake on recurrence of breast cancer in women aged below 35.
Who conducted the study?
The study was conducted byInternational Breast Cancer Study Group (IBCSG), a Swiss non-profit cooperative research organisation.
How was it done?
Over 3,000 women were enrolled in the study from over 500 hospitals, including Tata Memorial Hospital (TMH) in Parel. Of these, 350 were below 35 years. The women were divided into three groups. While one group was put on tablet-based tamoxifen drug, women in the second group were rendered temporarily infertile by suppressing their ovaries from releasing eggs while they were put on tamoxifen. In the third group, ovarian suppression was complemented with a new drug aromatase inhibitor exemestane. While exemestane is a standard drug used in treating women aged above 50, it's efficacy in women below 35 years was being tested for the first time.
What were the findings?
Breast cancer recurred in one of three women aged below 35 in the first group, who received tamoxifen. However, it recurred in one in six women in the third group who were given exemestane drug along with ovarian suppression. The study found that in women below 35 years suppressing ovaries combined with exemestane drug reduced the risk of recurrence by 35% as compared to giving women tamoxifen tablets alone.
"Also, suppressing ovaries and giving tamoxifen drug, as done with the second group, showed 22% less chance of recurrence," said Dr Vani Parmar, professor, department of breast oncosurgery.
Is ovary suppression safe?
Parmar said over 90% women whose ovaries were temporarily suppressed became fertile again at the end of the treatment.
And what about side effects?
While tamoxifen treatment has known high-risk side effects — thromboembolism or formation of clots in arteries, endometrial or uterine cancer — the more promising exemestane shows no such side effects. "However, exemestane is known to cause a decrease in bone density in women. The women who were part of the study received regular bone density scans to keep a tab on their bone health," said Parmar.
A word of caution
Parmar said, "The five-year study results are promising, but the type of tumours being treated in these studies mostly have a high recurrence rate even after five years, so longer follow-ups will have to be observed."
Grim statistics
Up to 23 Indian women in every 1 lakh get affected by breast cancer; 55% of these are pre-menopausal and aged below 50.
Every year, TMH sees close to 4,000 new breast cancer patients from across India, the youngest patient being 19 years old.
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