The Changing Approach to Breast Cancer Treatment

When 31-year-old Riya (name changed), who was recently married, was diagnosed with early-stage breast cancer, her immediate worry was whether aggressive treatments like chemotherapy would affect her chances of pregnancy. While chemotherapy can play an important role in reducing the risk of cancer returning, its potential effects on fertility made the treatment decision particularly significant for her.

For Riya, a recurrence risk prediction test, which indicates the likelihood of cancer returning after treatment, helped bring greater clarity to the decision. Her test results showed a low risk of recurrence, meaning the likelihood of her cancer returning was very low. Based on the findings and her oncologist’s assessment, chemotherapy was left out of her treatment plan. She underwent surgery and radiation, had a child the following year and later completed five years of hormone therapy.

Riya’s experience reflects a larger shift in breast cancer treatment. A cancer diagnosis no longer automatically means that every patient has to undergo the same treatment plan. There is now increasing focus on moving away from a one-size-fits-all approach to a personalized treatment approach that is much more beneficial for the patient. Oncologists today are looking beyond the tumour’s size and stage to understand its biology and determine which treatments are likely to benefit an individual patient.

This shift towards personalized care is particularly important for early-stage breast cancer, where some patients may be able to avoid chemotherapy without compromising their treatment outcomes.

Two women of the same age, same cancer with the same stage of the disease may require different treatment. Why? The answer lies in the tumour biology.

“Today, treatment decisions are guided by the genetic changes present in a particular tumour. Not all cancers are the same. One patient’s cancer may have a certain genetic makeup, while others may have a different genetic makeup. We design treatment plans based on the specific characteristics of each patient’s cancer. This is called personalised cancer treatment, where the treatment plan is tailored to the individual patient. This approach has now become the backbone of cancer treatment regimen,” explains Dr. Rakesh Reddy Boya, Senior Consultant, Medical and Hemato-Oncologist.

But how do doctors determine which treatment is most appropriate for an individual patient? Traditionally, treatment decisions have relied on clinical factors such as tumour size, grade, lymph node involvement and the stage of the disease. While these remain important, they may not always reveal how a particular tumour is likely to behave or how much a patient stands to benefit from chemotherapy.

This is where a deeper understanding of tumour biology can help guide treatment decisions. Prognostic tests are playing a big role in making this possible. A prognostic test gives doctors information about the biology of a tumour that may not be clear from its size, grade or stage alone. “They can provide additional information about the likelihood of cancer coming back and help doctors assess how much benefit a patient is likely to get from chemotherapy or other treatments,” explains Dr. Manjiri Bakre, CEO and Founder of OncoStem Diagnostics, the company behind CanAssist Breast, a prognostic test that predicts the risk of breast cancer recurrence. It analyses protein biomarkers in the tumour alongside clinical information to assess the likelihood of the cancer returning and helps doctors make a decision whether a patient can safely avoid chemotherapy.

The option to safely avoid chemotherapy - Financial, physical and emotional impact on patients

For patients, the possibility of safely avoiding chemotherapy can bring considerable relief. However, it can also raise concerns about whether opting out of treatment could increase the risk of the cancer returning. Balancing these concerns requires clear communication and evidence-based guidance from the treating oncologist.

Dr Praveen Dadireddy, Surgical Oncologist, says, “Today, evidence sits at the heart of patient counselling. It has become quite easy to persuade a patient. Simply present the data and let the evidence speak for itself. For most patients, the greatest reassurance comes from knowing that a safe, chemotherapy-free treatment plan is possible. When a patient first walks in, their biggest fear often stems from confusing the side effects of chemotherapy with the treatment itself. They dread the potential harms of chemotherapy. So, when you can develop an effective plan that avoids chemotherapy while still offering a complete cure, it becomes much easier for the patient to accept.”

Dr Rakesh Reddy Boya adds, “Most patients dread chemotherapy, as well as other cancer treatments, and not without reason. Chemotherapy has side effects and places a financial burden on patients. If we offer patients the option of avoiding chemotherapy, many would readily consider it. However, we must ensure that this decision is supported by scientific evidence and genuinely benefits the patient.”

Dr Praveen shares the example of a young woman in her late twenties who discovered a small breast lump while preparing for her marriage. After surgery, her tumour sample underwent OncoStem’s CanAssist Breast testing, and the resulting low risk of recurrence score helped guide a treatment plan involving hormone therapy and a short course of accelerated radiation. Her treatment was completed within five weeks, allowing her to move forward with minimal disruption to her plans.

These examples demonstrate how additional information can help oncologists and patients weigh the potential benefits and side effects of different treatment options. They do not mean that chemotherapy can be avoided in every early-stage case; rather, they indicate the need to tailor treatment decisions as per each patient.

While advances in prognostic testing have made more individualised treatment decisions possible, ensuring that these tools reach the patients who could benefit from them remains an important challenge. According to Dr. Rakesh Reddy Boya, access and awareness of prognostic tests should improve so that the benefits of personalized care can extend to many more patients.

As Dr. Manjiri Bakre of OncoStem Diagnostics, explains, “This is what personalized care should ultimately achieve: giving doctors better information to make treatment decisions while ensuring that patients receive the treatment they are most likely to benefit from.”

Ultimately, the shift from a one-size-fits-all approach is about recognising that every patient's cancer is different, even when the diagnosis appears similar. For a woman diagnosed with breast cancer, this can mean having a clear understanding of her treatment options, the potential benefits and risks, and how these decisions benefit her. The goal is not simply to reduce treatment, but to ensure that every patient receives the care she needs, guided by scientific evidence about her individual cancer.