Breast cancer impacts 2.1 million women each year, causing the greatest number of cancer-related deaths among women. In 2018, it is estimated that 627.000 women died from breast cancer, which is approximately 15% of all cancer deaths among women, with higher rates in more developed regions (WHO, 2018).
However, with advancements made in medicine, long term survival rates after a breast cancer diagnosis are steadily rising. Which may appear as good news, however this brings new challenges to the medical community, as breast cancer presents a chronic condition and their treatments holding multiple long-term side effects. The transition from patient of breast cancer to survivor of breast cancer is not always as smooth as imagined. With that, it is estimated that by 2020, there will be a predicted shortage of oncologists (American Society of Clinical Oncology, 2007), so the shift in care of these survivors come primary care physicians, and thus bringing the importance of physicians to be well educated in the long-term medical issues related to breast cancer treatment.
The first is cardiac issues. Chemotherapy has dramatically increased breast cancer survivorship outcomes, however unfortunately, many of the chemotherapeutic agents used have potential of causing cardiovascular complications, some acute but most are chronic. Taxane therapy side effects may lead to arrhythmias, particularly bradycardia. Cyclosphosphamide therapy can also lead to heart failure in nearly 30% of patients receiving the drug. However, most of the risks seem to be dose related.
Bone strength is affected secondary to prolonged estrogen blockage. Aromatase Inhibitors, which work by preventing the conversion of adrenal androgens into estrogens, are associated with a substantial and often rapid decrease in bone mass density and increased fracture risk. Long-term corticosteroid therapy is also a well-recognized risk factor for osteoporosis, by decreasing bone formations through several complex mechanisms.
Other drug effects include secondary malignancies, breast cancer-related lymphedema, and thromboembolic events.
However, most of these therapy effects can be minimalized with adherence and compliance in taking medications as prescribed for the length of time recommended. As the management of most malignancies are in the form of oral chemotherapeutic agents, these two factors play a vital role in ensuring the improvement of the disease. Adherence refers to taking the medicine as prescribed, while compliance addresses taking the medicine for the full term recommended, or more often referred to as persistence. Other than that, lifestyle changes which are focused on reducing BMI have demonstrated significant roles in extending survivorship outcome after breast cancer treatment.
In conclusion, breast cancer is no longer a death sentence for women. Mortality rates can be decreased with early detection and correct medication. It is our part as youths and as future medical practitioners to bring forth these advancements and help improve the breast cancer situation, especially in Indonesia.
- Bodai BI, Tuso P. Breast cancer survivorship: a comprehensive review of long-term medical issues and lifestyle recommendations. Perm J. 2015;19(2):48-79.
- Iyer R, Ring A. Breast cancer survivorship: key issues and priorities of care. Br J Gen Pract. 2017;67(656):140-141.