Breast cancer care is no longer one-size-fits-all

Breast cancer care is no longer a one-size-fits-all approach. (Envato Elements pic) When women hear the words "you have breast cancer," thoughts of surgery, chemotherapy and a challenging journey often come to mind. However, modern treatment is becoming increasingly personalized, taking into account not just the size or stage of the tumor but also the specific type of breast cancer and the individual woman.

Consultant clinical oncologist Dr Nisha Shariff explains that recognizing the subtype of cancer can significantly impact the treatment plan. Breast cancer comes in various subtypes, each behaving differently. Some cancers grow in response to hormones; others produce excessive amounts of a protein called HER2, which can promote cancer cell growth.

Triple-negative breast cancer lacks these common markers, requiring a distinct treatment approach. Knowing the type of breast cancer allows doctors to choose the most effective treatments. Two women with seemingly similar-sized and staged breast cancers might receive vastly different treatment plans. For example, one woman with a hormone-sensitive, HER2-negative cancer may undergo surgery, radiotherapy, and hormone therapy, while another with an HER2-positive cancer of a similar size may require chemotherapy and a medication specifically targeting HER2.

Factors beyond the cancer itself, such as age, overall health, menopausal status, and personal preferences, also play a role in treatment decisions. Doctors are treating not only the cancer but also the person living with it. "Aggressive" is a term that can instill fear, but it actually describes how the cancer behaves rather than predicting the ultimate outcome for a patient.

Some types, such as triple-negative and HER2-positive breast cancers, tend to grow more rapidly but may also respond exceptionally well to treatments specifically designed for them. Targeted therapy has significantly transformed outcomes for HER2-positive breast cancer, improving survival rates for many women. Personalized care also involves genomic testing, which examines patterns in the cancer to help doctors determine whether chemotherapy might be beneficial for a particular patient.

Alongside advancements in surgery, radiotherapy, and targeted medicines, treatment options have expanded. The focus has shifted from merely finding the best outcome to determining the most appropriate treatment for each patient, with a growing emphasis on survivorship. Despite these advancements, many breast cancers in Malaysia are still diagnosed at later stages.

Fear can be a barrier to screening, as some women avoid mammograms due to discomfort, embarrassment, or uncertainty about the results. However, delaying screening may mean missing the opportunity to find cancer earlier, when treatment could be simpler and more options are available. Early detection through mammograms can provide reassurance when no cancer is present, and when detected early, it is generally associated with better outcomes.

Nisha emphasizes that women should not let fear dictate their decisions, as knowledge is empowering. Addressing the emotional, physical, and practical aspects of breast cancer care is equally important. Women may require assistance in regaining strength, managing emotional well-being, coping with changes in body image or intimacy, addressing fertility concerns, and returning to work.

Consequently, breast cancer care now involves a multidisciplinary team rather than a single specialist. Support continues beyond active treatment. Dr Nisha Shariff concludes, "Cancer doesn't define you. It is one chapter of your life, not the whole story."