Management of Breast Cancer in Nepal

Abstract

Breast cancer is the second most common malignancy among women in Nepal. It is more commonin young premenopausal women. Breast cancer continues to increase in incidence due to lifestylechanges in Nepalese women despite constant remarkable development in the management of thisdisease over the past three decades. Breast cancer was diagnosed solely clinically and surgery wasthe only treatment option until fi fty years ago. Multidisciplinary approach has been adopted fordiagnosis and treatment of breast cancer in Nepal. Imaging is required for the diagnosis, appropriatetreatment decision and proper follow up. Treatment modality depends upon the extent of thedisease and tumor biology. However, there is a strong need for standard guidelines for the propermanagement of breast cancer in Nepal so that surgeries, chemotherapy, hormone therapy andradiotherapy are standardized in the country. Palliative care has been initiated to provide to somepatients with metastatic breast cancer recently.The breast cancer management in Nepal is a little different when compared with the centers in thedeveloped countries. The reasons are socioeconomic status, lack of education and lack of facilities.Although cancer care is on the rise in Nepal, the optimal facility for centers managing breast cancerhas to be improved signifi cantly.Cancer education, screening and early detection are the keyelements to infl uence the diagnosis, treatment and prognosis of breast cancer in Nepal. Breast cancerawareness and clinical breast examination are important tools for early detection in our resourcelimited context. Breast cancer can be cured in majority of the cases if diagnosed in early stages.This review will focus on relevant patient data along with future recommendation regarding breastcancer treatment in Nepal.Key Words: Breast cancer, cancer education, chemotherapy, imaging, radiotherapy, surgery

Problems of breast cancer survivors living in an urban area of Nepal

“…[2] The incidence of breast cancer in Nepal is high in perimenopausal women with the common age group of 41–50 years with Stage III being the most common stage. [345]…”

“…[4] A majority of the cases of breast cancer are managed with either radical or modified total mastectomy. However, the management trend is changing day by day with increasing preference toward breast-conserving surgery rather than total mastectomy, ranging between 6% and 15% in different cancer centers.…”

“…However, the management trend is changing day by day with increasing preference toward breast-conserving surgery rather than total mastectomy, ranging between 6% and 15% in different cancer centers. [34] Reconstruction surgery using muscle flaps is rarely performed in Nepal, and adjuvant chemotherapy and radiotherapy have regional variation. After completion of the primary treatment breast cancer patients with estrogen receptor positive cancer is treated with systemic hormonal therapy.…”

Breast Cancer in Nepal: Current status and future directions (Review)

“…A study by Youlden et al (3) in 2014 revealed that breast cancer was the most prevalent cancer and fourth leading cause of cancer-related mortality among women in Asia. In Nepal, according to the data from seven major cancer service hospitals in 2012, breast cancer was the second most common cancer among women, after cancer of the cervix (4,5). The risk of breast cancer increases exponentially up to the age of menopause, and increases at a slower rate thereafter (6).…”

“…Prevention has been demonstrated to be among the most effective long-term strategies to lessen the increasing chronic disease burden (7). However, due to socioeconomic disparities and insufficient financial resources, to date, the prevention of breast cancer has not been well conducted in Nepal (4). As a developing nation, Nepal is faced with several challenges with regards to the care of patients with breast cancer with inadequate funding; the uneven distribution of resources and services; inadequate numbers, training and distribution of health-care personnel and equipment; and a lack of adequate care for many populations based on socioeconomic and geographic factors (4).…”