Mrs Tulsi came to consult me on a Monday morning – “Doc, do you remember me?”
It took me a moment to recollect her – “How are you Mrs Tulsi? It’s been a long time since I saw you. How is your mother-in-law?”
“Oh, she passed away in 2020 due to COVID. She was 89 when she died. She lived a healthy and happy life after your surgery in 2006 – 14 long years.”
“I am sorry to hear about your mother-in-law, Mrs Tulsi. Tell me, how can I help you today?”
“Doc, I’ve come to you because I noticed a lump in my breast. I met my doctor in my home town, and I’ve done these tests. I have come here because I want you to do my surgery.”
I went through her test reports – all necessary tests had been done. She had a stage 2, HER2 positive breast cancer.
“So, how soon can we do the surgery?” she asked.
“Mrs Tulsi, you have early stage breast cancer of a type we call HER2 positive. Since its in an early stage, there is a very high chance of cure. And yes, surgery is your primary treatment. But in your case, I would advise that you start chemotherapy and targeted therapy first, and we do the surgery after a few months.”
“I don’t understand. Shouldn’t I get the cancer removed first? Won’t it spread if we don’t remove it soon? For my mother-in-law, I remember you did the surgery first. How can it be different now?”
Her questions were genuine and valid. But there are clear answers. Medical science is a rapidly developing field – and this is especially true of oncology. The standard of care keeps evolving. Newer treatments become available, leading to better outcomes.
When I was a resident in training, adjuvant chemotherapy (chemotherapy after the main or primary treatment) following surgery was advised only for patients with breast or colorectal cancers and for some sarcomas of the bone. Neo-adjuvant chemotherapy (chemotherapy before primary treatment) was only recommended when it was not possible to operate (inoperable cancers). Over the years, adjuvant therapies became a standard of care for more and more cancers. Neo-adjuvant treatment began to be given even in early operable cancers. These modifications are not arbitrary – changes are made only on the basis of results of high-quality scientific research.
Today, even as we speak, there are innumerable clinical trials going on to see if oncology treatments can be made even better. Not all trials show a positive result. Even when they do, it takes a lot of analysis, scrutiny, and sometimes conducting bigger trials with larger number of patients before modifying established treatments.
Mrs Tulsi followed my advice and took neoadjuvant therapy. Four and a half months later, she underwent breast conservation surgery – the tumor had responded completely to the neoadjuvant treatment – this is an additional marker of good prognosis. I expect she will have a long and healthy life.
Mrs Tulsi received treatment which was different from what her mother-in-law received, even though both had the same disease. This is because of developments in medicine over 15 years. In the next few years, things may change further. And these are changes for the better.