Indian J Med Res
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Cardiovascular disease (CVD) and breast cancer cause substantial morbidity and mortality in women and are major public health concerns. Breast cancer survivors are at a greater risk for CVD-related mortality compared to women without breast cancer. ⋯ With improvements in breast cancer prevention and treatment, there is a significant improvement in survival and this shifts focus from disease control to long term effects of treatment and quality of life. Assessing CVD and minimizing complications from cancer therapy are important treatment goals.
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The global increase in cancer burden is a challenge for countries with scarce resources. Amongst all the malignancies, gynaecological cancer still continues to have a high incidence and prevalence leading to significant morbidity and mortality. While a multipronged strategy of decreasing the gynaecological cancer burden is a global priority, one of the key strategies to decrease the morbidity and mortality is to train gynaecological oncology specialists. ⋯ While it is a positive step to initiate such training programmes in a country like India, there are still gaps in the uniformity of curriculum and training. Also, exposure to modern practices in gynaecologic oncology surgery, chemotherapy and technology in radiation oncology, especially brachytherapy, is still insufficient in many centres. This review discusses some of the challenges and opportunities in the still evolving programmes for training gynaecologic oncologists in India.
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Cancer has been one of the leading causes of death in India in the past decade. The growing cancer burden has generated an unmet need to identify and address gaps in the healthcare system to enable access to affordable and quality cancer care for all in a manner that enhances the value of care. ⋯ The core characteristics of patient centricity - heterogeneity and complexity - are detailed to complement and expand on previously defined aspects of value-based care. Comprehensive value-based cancer care can serve as a test case and proof of concept for the rest of the health system in India and focusing on women's cancers as a starting point can mandate attention to gender-responsive and transformative design and implementation.
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Breast cancer is the most common cancer among women in India, and adjuvant radiotherapy is an integral part of curative treatment in most patients. The recent decades have witnessed several advances in radiation therapy delivery. Several advances in radiation oncology have been identified which include technological advances, change in fractionation used, use of cardiac-sparing radiotherapy as well as efforts to personalize radiotherapy using accelerated partial breast irradiation or avoidance of radiotherapy in certain subpopulations. ⋯ However, increasing emphasis on research in these areas is needed so that effectiveness and safety in our setting can be established. Advances in breast cancer radiotherapy have resulted in improved outcomes. Data published from India suggest that these improved outcomes can be replicated in patients when appropriate treatment protocols are followed.
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Multicenter Study
Consensus on contentious issues relevant for breast cancer management for the Indian scenario: Statements following a multicentre expert group meeting.
Management of breast cancer is multidisciplinary requiring critical analysis of emerging evidence especially with its appropriateness to local practice. A high level expert committee meeting was held to arrive at a consensus on controversial practical breast cancer management policies for Indian patients. Indian experts (n=39) from government and private centres who were part of the breast cancer multidisciplinary group, participated in the consensus meeting. ⋯ An overwhelming consensus was received in 51 of the 58 questions. The group considered the available evidence with a view for its practical applicability in Indian patients. This consensus document may aid in shaping breast cancer care for the breast oncology practitioners as well as the policymakers in the country.