Late effects of treatment in breast cancer survivors: A statistical update.

Dear Editor,

We read with much interest the article entitled “Late effects of cancer treatment in breast cancer survivors”.[1] It's a nicely written review article and Agrawal has comprehensively elaborated the various late effects of chemo-radiotherapy in breast cancer survivors. However, the statistical data provided by Agrawal about the cancer survival in US is not up to date and is about a decade old.[2] Similarly, the data elucidated for breast cancer survival in India is also nearly a decade old.[3] The medical technologies are advancing day by day, so being provided with a decade old information may underestimate/overestimate the problem and may not reflect the actual healthcare scenario in addition to putting a curtain over the advancements/deterioration in cancer management strategies in this period lag. hence, in our opinion, it would have been better if the author would have included the recent cancer-related data from these countries.

Agrawal has mentioned that in the US, 5 years survival rate is 64% for adults whose cancer is diagnosed today and out of this, breast cancer survivors makeup the largest group of cancer survivors (22%), followed by prostate cancer survivors (17%) and colorectal cancer survivors (11%). But the recent cancer statistics, 2014[4] provided by the American Cancer Society, have concluded that the 5-year survival rate from 2003 to 2009 was 68% for all sites and overall, the risk of dying from cancer decreased by 20% between 1991 and 2010. Particularly for breast cancer, the 5-year survival rate increased statistically significantly (P < 0.05), to 90% in 2003-2009 from only 75% in 1975-1977. A total of 1,665,540 new cancer cases and 585,720 cancer deaths are projected to occur in the United States (US) in 2014.[4] The breast cancer alone is expected to account for 29% (232,670) of all new cancers among women in 2014. Death rates for breast, prostate, and colorectal cancers are down from peak rates by 34%, 45%, and 46%, respectively, as a result of improvements in early detection and treatment.[4] This exhaustive data shows that the US is determinant on the move to fight against cancer and is headed in the right direction.

Agrawal has mentioned that the actuarial survival data of Indian breast cancer patients with early stage disease at 10 years in is 77%. The recent report by Globocan[5] for the year 2012 shows that the incidence of breast cancer is increasing worldwide. The overall 5 year survival for breast cancer in the US increased from 75% in 1970s to almost 89% in 2012. However, statistics available for India for 2012 are barely similar, with survival rate <60%.[5] The western nations have achieved a steadily improving and good survival mainly because of effective screening of breast cancer.[5] In India, >50% patients of cases present in stages 3 and 4, and so the outcome is not as good as earlier stages, however aggressive the treatment may be.

With the above most recent statistics, we can realize that India needs to gear-up for improving the health care facilities for early diagnosis and management of breast cancer. So, let us keep all our shyness of talking about breast and fear of talking about breast cancer aside and spread the word of awareness about the importance of regular breast self-examination and screening in the early detection of breast cancer.

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Conflicts of interest

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