Technologies like fluorescence imaging are used which identify lymph nodes on the operating table and enable selective removal.
We are living in difficult times. This pandemic has led us to alter our lives in so many ways. We are restricted to our homes, there is a constant fear and stress about contracting the virus. Healthcare infrastructure has turned upside down. This has somewhere led people to ignore other ailments as they are worried to go to hospitals for consultations, treatments etc. But let’s not forget that the virus is here to stay, and so, do not let corona fear eat you up.
Ignoring your disease may now trade one public health crisis for another. Breast cancer is one such disease, which is the most common of all cancers in India and is on rapid rise, especially amongst young women.
When technology leads the fight against breast cancer
Of the many cancers the world has fought over the years, breast cancer has claimed 627,000 lives globally. The total number of cases around the world stands at a whopping 2.09 million.
More alarming is the fact that in the Indian context, breast cancer accounts for 14 per cent of all cancers in women, and the latest statistics reveals that every four minutes, one woman is diagnosed with breast cancer in the country. Reasons being poor lifestyle, longer working hours, increasingly stressful lives, smoking, alcohol consumption, use of contraception. While we have come a long way in combating this disease burden with new tools of early detection, screening and diagnosis, we know that the outcomes and survival rates are still threatening in most countries, especially in the developing nations like India.
The key to transforming the care on breast cancer is early detection. Therefore, it is important to shed light on one of the most life-threatening cancers women around the world suffer from and how early diagnosis proves to be beneficial for the safety of our women.
Acknowledging the roadblocks
The most critical aspect of breast cancer disease burden is the lack of awareness on the subject. Most women do not know enough about it to get themselves diagnosed early. A major challenge is the limited resources and infrastructure and health systems, leading to late diagnosis of the disease at a much later stage. For any woman, if you observe any of the following symptoms, it is crucial to consult the doctor:
Lump in the breast or underarm
Thickening or swelling of part of the breast
Irritation or dimpling of breast skin
Redness or flaky skin in the nipple area or the breast
Pain in the nipple area
Nipple discharge other than breast milk, including blood
At times like these, when one cannot immediately visit the hospital, doctors are available for tele-consultation. Upon their advice, you can go for the diagnosis. Remember that prevention and early detection is key to tackling cancer.
Using technology to better patient outcomes
It’s interesting to know that technological advancements have not only made screening and diagnosis better but have also helped improve patient outcomes during cancer surgeries. For instance, we now use fluorescence imaging technology to get clinically important and real time actionable information.
Let’s understand this with an example. Breast cancer is a disease in which the breast cells grow uncontrollably, and this can happen in any one of the three parts of the breast— ducts (the tubes that carry milk to nipples), lobules (milk-producing glands) or the connective tissue. Now, in case if a patient observes any breast cancer symptom, it is first diagnosed and localised before surgery by imaging devices like mammography/MRI and minimally invasive biopsy, but during surgery, it is often challenging to spot the exact location of the cancer cells with the naked eye or conventional tracer.
Now, when it comes to breast cancer, it is critical to know whether the cancer has spread from primary tumour to other locations or not. This information is used to decide if all the lymph nodes need to be removed or only some.
This is where evolved tools and instruments are making a difference. We now use technologies like fluorescence imaging which identify lymph nodes on the table and enable selective removal.
For instance, the technology helps view lymph nodes by way of illuminating them in fluorescent green colour that is invisible to the naked eye --- the image of the nodes can only be seen on the monitor. Just 15 minutes before the surgery, indocyanine green (ICG) dye is injected into the breast, near the tumour into the areola. The ICG follows the natural lymphatic ducts and concentrates on the lymph nodes, allowing the surgeon to see which nodes are likely to be affected by cancer. When viewed under fluorescence imaging, these nodes and tumour can be viewed in a fluorescent green colour. This improves clinical accuracy in the staging of cancer. With precision and selected removal, several post-op complications like the sensory deficit, pain, and impaired arm movement can be avoided.
Into the future with science and awareness
To effectively fight the disease burden of breast cancer, we need evolved technologies like fluorescence imaging which are quite beneficial in laying out the road to detect the spread of cancer with better precision and in preventing complications in breast cancer surgeries. Another important factor that cannot be ignored is the importance of breast cancer screenings. Every woman should be taught at an earlier stage in life to look out for symptoms. Additionally, lifestyle changes like regular exercise, yoga and dietary restrictions can also help in bringing down this burden.
(The author is professor and head, department of surgical oncology, AIIMS, New Delhi)