Live Discussion with Dr. Jalaj Baxi
Questions doctors asked during the Jivo Masterclass on Diagnosis and Management of Breast Cancer, taught by Dr. Jalaj Baxi, Senior Consultant, Surgical Oncology, Fortis Hospital, Noida, India, on . Written by Jivo Healthcare from the transcript of the session, drafted with AI assistance and edited by the Jivo team.
In what situations is prophylactic mastectomy appropriate in early-stage breast cancer?
Asked by Moderator
Mainly in patients with a genetically determined high risk, such as those who test positive for BRCA1 or BRCA2 mutations or other high-risk genes. BRCA testing is done only when there is a history of breast cancer in the family.
Answered by Dr. Jalaj Baxi
What modalities help prevent reactions to anti-cancer drugs and reduce mortality during chemotherapy?
Asked by Moderator
Mortality in chemotherapy is a fairly rare event, and when it happens it is almost always due to bone marrow suppression. The key is giving chemotherapy under close supervision so that this suppression is caught early, since early detection is what actually prevents mortality.
Answered by Dr. Jalaj Baxi
How does surgery compare with radiotherapy for local control in advanced-stage breast cancer?
Asked by Moderator
In advanced-stage breast cancer, chemotherapy comes first, and if the patient responds and surgery becomes feasible, surgery should be done, followed by radiotherapy to the chest wall and regional nodes, which remains a standard part of treatment. Radiotherapy in place of surgery comes in when the patient refuses surgery or surgery cannot be done. The results of surgery and radiotherapy alone cannot really be compared in advanced cancer.
Answered by Dr. Jalaj Baxi
What are the natural causes of breast cancer?
Asked by Moderator
There is no true natural cause; the underlying event is always a gene mutation. About 80% of cases are sporadic mutations with no identifiable cause, while 10 to 15% are genetic or familial. Alcohol is a risk factor for cancer as a whole rather than for breast cancer in particular, and smoking also contributes; both should be avoided.
Answered by Dr. Jalaj Baxi
On an evolutionary level, how does breast cancer differ between men and women?
Asked by Moderator
There is no such differentiation in the basic biology. Male breast cancer is almost always hormone-receptor positive, as most female breast cancers are, and the treatment remains the same. Nothing distinguishes which one will develop cancer and which will not.
Answered by Dr. Jalaj Baxi
Is there a correlation between certain cosmetics, such as talc or lipstick, and the development of breast cancer?
Asked by Moderator
Various myths and misconceptions exist around this, including the use of talc in the axilla. Some print media point to possible links, but there is no confirmatory or corroborative evidence for a connection between cosmetics and breast cancer.
Answered by Dr. Jalaj Baxi
A 65-year-old woman has metastatic breast cancer; mastectomy is not feasible and she has been started on chemotherapy. What chemotherapy regimens are appropriate, and how many courses?
Asked by Dr. Atandanda Solomon
The regimen depends on the tumour's biology, whether it is ER positive, PR positive or HER2 positive, and that decides the type of treatment: chemotherapy with an anthracycline or a taxane, hormonal therapy where the receptors are positive, and HER2-directed therapy where HER2 is positive. Chemotherapy runs six to eight courses, and HER2-directed treatment in metastatic HER2-positive disease runs around 20 cycles.
Answered by Dr. Jalaj Baxi
Can chemotherapy be combined with hormonal therapy, and what other management plans and success rates apply in metastatic disease?
Asked by Dr. Atandanda Solomon
Yes, chemotherapy can be combined with hormonal therapy. Other management plans depend on the tumour's biology and how the patient responds. The success rate also depends on response, but the published figures are that 30 to 35% of patients with metastatic breast cancer respond very well. If the patient responds very well, the metastases can be treated as well and surgery can be done.
Answered by Dr. Jalaj Baxi
If a patient remains symptomatic after the eighth course of chemotherapy, what other treatment options are available?
Asked by Dr. Atandanda Solomon
Immunotherapy can be added, and the chemotherapy can be changed: second-line and third-line regimens are available, as are CDK4/6 inhibitors for hormone-receptor positive disease. The tumour should be tested again by next-generation sequencing (NGS), which identifies newer drugs likely to be effective for that patient.
Answered by Dr. Jalaj Baxi
Why do many patients' health seem to deteriorate immediately after a breast cancer diagnosis?
Asked by Moderator
This is largely psychological rather than driven by the disease itself, a kind of cancer phobia that sets in once the diagnosis is given, where the patient loses a sense of control over their own life and fears dying early or being treated inadequately. Educating patients about their specific disease and realistic treatment outcomes helps restore the sense that there is still a fight to be had, which improves how they cope.
Answered by Dr. Jalaj Baxi