Breast Cancer Management: Bangladesh scenario

Worldwide, breast cancer is the leading malignancy among females and Bangladesh is not an exception. Though, the exact incidence in our country is not known due to the lack of National Cancer Registry. From the available hospital registries of different hospitals, it is rational to say that, in Bangladesh, it is also number one malignancy among our female population. The mortality from breast cancer is also substantial. According to American Cancer Society's estimate for breast cancer in USA for 2022 are: about 287,850 new cases of invasive breast cancer will be diagnosed in women and about 51,400 new cases of ductal carcinoma in situ (DCIS) will be diagnosed. About 43,250 women will die from breast cancer in USA in 2022.

As breast cancer incidence has been increasing worldwide, different scientific research bodies in technically advanced countries have long been involved with research, new innovations and for the development of new guidelines for management of breast cancer. Management guidelines are changing very frequently for screening, diagnosis, investigations and treatment of different types and different stages of breast cancer.

 To provide the latest management to our patients, we oncologists must be at per with these everchanging advances by keeping ourselves busy with training and continual medical education (CME). Our hospitals and diagnosis centers, also, should acquire the necessary equipment, reagents, diagnosis kits and set up standard labs with molecular diagnosis facilities, including facility for next generation sequencing (NGS) etc. Government/professional based accreditation bodies should be set up to monitor the standard of these advanced labs and they should be categorized according to their available resources and services they provide. If possible, USFDA approved lab and diagnosis facilities may be established so the margin of error is minimized.

It is a great pleasure that in recent years many new developments in cancer care have evolved in Bangladesh in different centers. We now have few comprehensive cancer care centers in Dhaka, immunohistochemistry investigations are available in few centers which is of immense importance when we initially categorize breast cancer in different subtypes where treatment options and sequencing of treatments are very different for each type. Staging of breast cancer is also a very important factor for the management of breast cancer. Therefore, we have, also, equipped some centers with all the cancer staging facilities including PET-CT scan.

For screening of breast cancer where breast cancer may be diagnosed at a very early stage, even when it is not palpable, can be achieved by mammogram or in some cases with breast MRI. Few centers in Dhaka have developed these facilities. They play immensely important role in the early diagnosis and management of breast cancer. When diagnosed by these modalities as early stage I breast cancer, usually, the cost of total management is low, the chance of cure is high, and the duration of management is sometimes shorter.

Regarding treatment availability in Bangladesh, Dhaka city has developed few comprehensive cancer centers where, from diagnosis to staging and all management facilities are available under the same roof. All chemotherapy, targeted therapy, hormone therapy and breast cancer related immunotherapy which are commonly used are available in Bangladesh. Very up to date Radiotherapy facilities are also available in few centers where all the conventional and short duration radiotherapy are practiced regularly, ensuring the patient and staff protection according to IAEA guidelines.

Very well-trained physicians, surgeons trained and experienced in breast cancer surgeries of different types, physicists, technicians, BSC and MSC pharmacists and nursing staff now cater to the need of breast cancer patients in few reputed hospitals.

Multi-disciplinary tumor board (MDTB) facilities are also available in some centers to ensure proper management of difficult cases of breast cancer as breast cancer treatment usually is a multi-modality management where different types of management such as surgery, chemotherapy, targeted therapy, immunotherapy and radiotherapy are needed according to the type, age and comorbidities of the patient and the stage of breast cancer.

Therefore, to end this discussion, it is not a bad picture in terms of breast cancer management in Bangladesh. However, only very few hospitals are well equipped to cater to all these facilities under a common umbrella.

We need to ensure many more standard hospital and diagnostic facilities of international standard with accreditation from very reputed international bodies to cater to the huge population of cancer patients, especially breast cancer patients in Bangladesh.

We have to realize that receiving appropriate up to date cancer management from diagnosis to treatment is a patient's right. Therefore, all efforts should be present to prevent any maltreatment or malmanagement of our patients by the appropriate bodies.

The author is a Senior Consultant and Coordinator at the Department of Medical Oncology, Evercare Hospital.