The Indian Council of Medical Research (ICMR) has issued a consensus document for management of breast cancers. This consensus document summarises the modalities of treatment including the site-specific anti-cancer therapies, supportive and palliative care and molecular markers and research questions. It also interweaves clinical, biochemical and epidemiological studies.
The consensus document is based on review of available evidence about effective management and treatment of cancers in Indian setting by an expert multidisciplinary team of oncologists whose endless efforts, comments, reviews and discussions helped in shaping this document to its current form. This document also represents as first leading step towards development of guidelines for various other cancer specific sites in future. Development of these guidelines will ensure significant contribution in successful management and treatment of cancer and best care made available to patients. This document would help practicing doctors, clinicians, researchers and patients in complex decision making process in management of the disease.
This document has been designed to optimize the outcome of the patients based on the available evidence as well as the resources at majority of the regional cancer centres. This will bring uniformity in the practice of this disease at various cancer treatment centres and thus promote seamless collaborative studies to address India specific research questions.
Breast cancer is the most common female cancer in the world with an estimated 1.67 million new cancer cases diagnosed in 2012. While the age adjusted incidence rates of breast cancer in India is lower than the western countries, because of the large population, the burden of breast cancer is high. With an annual incidence of approximately 1,44,000 new cases of breast cancers in India, it has now become the most common female cancer in urban India.
There is general consensus in Indian oncologists regarding the use of surgery, with breast conservation when feasible and the indication for radiotherapy, chemotherapy and hormone therapy in various stages of breast cancer. Breast conservation rates are low even for stage I & II breast cancers in most Indian centres and reflects the lack of access to modern radiotherapy. The quality of mastectomy, axillary lymph node dissection and pathology reporting varies significantly across the country. The choice of chemotherapy regimen and hormonal agents for different stages of breast cancer is determined not only by the prognostic and predictive factors but also by the logistics and access. Similarly the treatment for recurrent or metastatic disease is not uniform and is governed by several factors including the previous treatment, patient’s ability to tolerate additional treatment and access to such treatment.