Mucositis as a side effect in breast cancer treatment and how to manage it – Times of India

Breast cancer is the most common cancer among women in India, accounting for 14% of all female cancers. In 2020, around 178,000 new cases were reported, with about 90,000 deaths. Urban areas see higher incidence rates compared to rural regions, primarily due to lifestyle changes. Early detection remains a significant challenge, with many cases diagnosed at later stages, contributing to lower survival rates compared to Western countries.Factors like limited awareness, delayed diagnosis, and inadequate access to treatment facilities worsen outcomes. To reduce mortality, increasing screening, improving public awareness, and enhancing healthcare infrastructure are essential steps. Hereditary factors play a role in 5-10% of breast cancer cases, most often linked to mutations in the BRCA1 and BRCA2 genes. Women carrying these mutations have a considerably higher risk of developing breast cancer. A family history of breast, ovarian, or other cancers further increases the risk of hereditary breast cancer. Regular screening is a critical tool in reducing breast cancer mortality, as early detection dramatically improves survival rates. Mammograms, self-exams, and clinical breast exams are essential in catching breast cancer early when it is most treatable, particularly for women over 40 or those with a family history of the disease.

Breast cancer treatment in India follows a multidisciplinary approach. After diagnosis through imaging and biopsy, treatment is tailored based on the cancer’s stage. For early-stage cancers, surgery—such as a lumpectomy or mastectomy—is often the first step, followed by radiation therapy. In more advanced (locally) cases, chemotherapy, targeted therapy, immunotherapy, or hormonal therapy may be administered before surgery to shrink the tumor. Post-surgery, additional treatments like chemotherapy, radiation, or hormone therapy help prevent recurrence. A particularly challenging type of breast cancer, Triple Negative Breast Cancer (TNBC), is treated with a combination of chemotherapy, immunotherapy, surgery, and radiation. Treatment plans depend on the type of tumor, the patient’s overall health, and access to medical facilities. Personalized treatment protocols and clinical trials are increasingly available, especially in urban centers.

Breast cancer treatment may cause various side effects. Surgery may result in pain, swelling, or restricted arm movement. Chemotherapy can lead to hair loss, nausea, fatigue, anemia, mucositis, and a higher risk of infection. Radiation therapy often causes skin irritation, fatigue, and sometimes permanent changes like breast tissue hardening. Hormonal therapy can trigger menopausal symptoms like hot flashes, mood swings, and bone thinning. Targeted therapies, while generally less toxic, can still cause fatigue, diarrhea, and skin issues. A common concern after lymph node removal is lymphedema (arm swelling). Most side effects are reversible and can be managed effectively with supportive care, readily available at multidisciplinary centers.
Mucositis, a common side effect of chemotherapy, has garnered media attention recently. It could be seen in 15-20% of patients receiving chemotherapy for their breast cancer treatment. Mostly patients develop very mild mucositis but rarely the presentation could be severe. This condition involves inflammation and ulceration of the mucous membranes, especially in the mouth and digestive tract. Chemotherapy drugs impact rapidly dividing cells, including those in the mouth and gastrointestinal tract, leading to painful sores, difficulty swallowing, and a heightened infection risk. Although mucositis is usually short-lived, it can temporarily affect nutrition and quality of life. Early intervention, including good oral hygiene, pain relief, and protective oral rinses, is key to managing this condition. Severe cases may require adjusting chemotherapy doses or taking breaks from treatment.
In 2024, breast cancer treatment has significantly advanced, with breakthroughs in targeted therapies, immunotherapy, and personalized medicine. These innovations are improving survival rates and enhancing quality of life for patients. Early detection and new treatment options mean more women are living longer, healthier lives. Effective management of treatment side effects also plays a crucial role in improving outcomes and reducing the overall burden of breast cancer treatment.
(Author: Dr. Sewanti Limaye, Director of Medical & Precision Oncology, at Sir H. N. Reliance Foundation Hospital)