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The management of breast cancer has become increasingly complex and multidisciplinary in the recent past. Further, there are unique constraints and opportunities for cancer care delivery in India, including socioeconomic, geographic, and other disparities. Therefore, the Indian Society of Medical and Paediatric Oncology convened a panel of experts to create evidence and context-based guidelines for the management of early breast cancer. [ABSTRACT FROM AUTHOR]

Cancer management is an expansive, growing, and evolving field. In the last decade or so, immunotherapy (IT) and particle beam therapy have made a tremendous impact in this domain. IT has already established itself as the fourth pillar of oncology. Recent emphasis has been centred around combination therapy, postulating additive or multiplicative effects of combining IT with one or more of the three conventional "pillars," that is, surgery, chemotherapy, and radiotherapy. Radio‐IT is being increasingly explored and has shown promising outcomes in both preclinical and clinical settings. Particle beam therapy such as protons, when used as the radiotherapeutic modality in conjunction with IT, can potentially limit toxicities and improve this synergism further. Modern proton therapy has demonstrated a reduction in integral dose of radiation and radiation‐induced lymphopenia in various sites. Protons, by virtue of their inherent clinically desirable physical and biological characteristics, namely, high linear energy transfer, relative biological effectiveness of range 1.1–1.6, and proven anti‐metastatic and immunogenic potential in preclinical studies, might have a superior immunogenic profile than photons. Proton‐IT combination is being studied currently by various groups in lung , head neck and brain tumors, and should be evaluated further in other subsites to replicate preclinical outcomes in a clinical setting. In this review, we summarize the currently available evidence for combinatorial approaches and feasibility of proton and IT combination, and thereafter highlight the emerging challenges for practical application of the same in clinics, while also proposing plausible solutions. [ABSTRACT FROM AUTHOR]

The incidence of breast cancer is increasing rapidly in urban India due to the changing lifestyle and exposure to risk factors. Diagnosis at an advanced stage and in younger women are the most concerning issues of breast cancer in India. Lack of awareness and social taboos related to cancer diagnosis make women feel hesitant to seek timely medical advice. As almost half of women develop breast cancer at an age younger than 50 years, breast cancer diagnosis poses a huge financial burden on the household and impacts the entire family. Moreover, inaccessibility, unaffordability, and high out-of-pocket expenditure make this situation grimmer. Women find it difficult to get quality cancer care closer to their homes and end up traveling long distances for seeking treatment. Significant differences in the cancer epidemiology compared to the west make the adoption of western breast cancer management guidelines challenging for Indian women. In this article, we intend to provide a comprehensive review of the management of breast cancer from diagnosis to treatment for both early and advanced stages from the perspective of low-middle-income countries. Starting with a brief introduction to epidemiology and guidelines for diagnostic modalities (imaging and pathology), treatment has been discussed for early breast cancer (EBC), locally advanced, and MBC. In-depth information on loco-regional and systemic therapy has been provided focusing on standard treatment protocols as well as scenarios where treatment can be de-escalated or escalated. [ABSTRACT FROM AUTHOR]

In a rapidly evolving world, with a steep rise in breast cancer incidence, there has been many advances in imaging and therapeutic options of breast cancer care. In this review article, we are trying to cover imaging guideline for cancer detection and their therapeutic options. These help in the reduction of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Young (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying. The YBC treated with a curative intent between 2015 and 2016 at our institute were analysed. There were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients. More than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus. • Largest data of young breast cancer from India analysing demographics, outcomes and fertility. • Higher proportion of YBC with advanced stage and aggressive features compared to western data. • Inferior survival in HER-2+ not receiving Trastuzumab, need access of life saving drugs to all. • Scope of improvement and collaboration in challenges like fertility, pregnancy and quality of life. [ABSTRACT FROM AUTHOR]

Pregnancy associated breast cancer (PABC) is a rare entity and defined as breast cancer diagnosed during pregnancy or one-year post-partum. There is sparse data especially from low and middle-income countries (LMIC) and merits exploration. The study (2013–2020) evaluated demographics, treatment patterns and outcomes of PABC. There were 104 patients, median age of 31 years; 43 (41%) had triple-negative disease, 31(29.8%) had hormone-receptor (HR) positive and HER2 negative, 14 (13.5%) had HER2-positive and HR negative and 16(15.4%) had triple positive disease. 101(97%) had IDC grade III tumors and 74% had delayed diagnosis. 72% presented with early stage (24, EBC) or locally advanced breast cancer (53, LABC) and received either neoadjuvant (n = 49) or adjuvant (n = 26) chemotherapy and surgery. Trastuzumab, tamoxifen, and radiotherapy were administered post-delivery. At a median follow up of 27 (IQR:19–35) months, the estimated 3-year event-free survival (EFS) for EBC and LABC was 82% (95% CI: 65.2–100) and 56% (95% CI: 42–75.6%) and for metastatic 24% (95% CI: 10.1%–58.5%) respectively. Of the 104 patients, 34 were diagnosed antepartum (AP) and 15 had termination, 2 had preterm and 16 had full-term deliveries(FTDs). Among postpartum cohort (n = 70), 2 had termination, 1 had preterm, 67 had FTDs. 83(including 17 from AP) children from both cohorts were experiencing normal milestones. Data from the first Indian PABC registry showed that the majority had delayed diagnosis and aggressive features(TNBC, higher grade). Treatment was feasible in majority and stage matched outcomes were comparable to non-PABCs. • Pregnancy associated breast cancer (PABC) is a rare and Challenging entity with lack of data from low-middle income countries. • First Indian data showed that stage matched oncologic outcomes were comparable to non-PABC. • Obstetric outcomes were similar to non-cancer associated pregnancies with normal cognitive development. • Creating awareness and early diagnosis is of utmost importance to improve prognosis in this unique entity [ABSTRACT FROM AUTHOR]

Cancer is among the leading causes of deaths worldwide. The treatments of cancer across most sites involve using surgery, systemic therapy, and radiation therapy. The treatment protocols are complex and require careful planning at the beginning of the therapy and coordination between the treating teams, the patient, and the caregivers to ensure compliance and avoid unnecessary treatment delays. This commentary provides an insight into the role the multidisciplinary joint clinics play in providing personalized cancer care. While such joint clinics are advantageous, they are not devoid of drawbacks and these are also enumerated. In this era, when communication platforms are increasingly digitized, we have highlighted the need for virtual tumor boards. The commentary aims to motivate the development of multidisciplinary joint clinics for ensuring holistic cancer care across the country. [ABSTRACT FROM AUTHOR]