Breast Cancer India
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best course after cancer detection?

best course after cancer detection?

Following tool is hosted by Public Health England and Cambridge University. predict.nhs.uk/predict_v2.0...

PREDICT is an evidence based tool designed for patients and doctors to help them decide on the ideal course of treatment following breast cancer surgery.

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I believe their is sound scientific basis behind this tool. I calculated survival with a not so random scenario. I am wondering what happens to those 73.6 women in 10 years? They cure them self, cancer stops progressing, does not impact daily life?

In this graph I see all the medications add ~16% survival at 10 year mark, (with significant deterioration in quality of life), why these medications considered a significant achievement or best course after cancer detection?

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Whether this shows 100 actual patients studied or % of patients studied, something is wrong with the math. The numbers, both for five years and ten years, when added, come out to more than 100 or 100% and the graphs don't match the numbers. What am I missing?

Statistics are about what has already happened and by the time they are released they are several years behind current results. More importantly, we are not statistics. They are useful for researchers, but can't predict how an individual patient will respond. We are individual and unique. I was supposed to be dead five years after my leukemia diagnosis. That was 15 years ago - 10 years ago for my added breast cancer. I'm still here!

Find an oncologist who is up to date on approaches to breast cancer, and a surgeon who focuses on breast cancer and work with them to plan the best treatment plan for you.

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The following FAQ link has details about this tool, I am just copying one answer to keep post shot. predict.nhs.uk/faqs.html

Who developed the PREDICT programme?

How was the computer programme developed?

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How do I know that PREDICT gives the right answers?

Every effort has been made to make sure that PREDICT gives the correct answer based on our current knowledge. Our findings are based on women treated in the East of England but we have also tested that they give the same results on nearly 5,500 women treated in the West Midlands. To the best of our knowledge the PREDICT tool works equally well for all women in the UK. We have also tested PREDICT on over 3,000 women treated in British Columbia, Canada.

The theory behind PREDICT and the results have been presented to leading breast cancer clinicians from across the world at the 32nd Annual San Antonio Breast Cancer Symposium, in 2009 at San Antonio, Texas USA. Three scientific papers describing the work have been reviewed by scientists and clinicians (see Publications for details).

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I understand that 10-year graph is the continuation of the 5-year graph.

My post is about this figure of 73.6.. (after that you may extend to all add up numbers to that ..), not really about the efficacy of one treatment plan or another.

"I am wondering what happens to those 73.6 women in 10 years? They cure them self, cancer stops progressing, does not impact daily life, or they are able to sustain with cancer?"

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Women should not be directed to a "tool" like this! They should be directed to a competent doctor with the medical training to evaluate their individual case!

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Thanks for your reply,

Two different competent doctors may not give you the same advice. Many times they also leave on the patient to take a decision (may not be in direct words but indirectly), the patient needs to know different tradeoffs, more often it happens at a later stage then the decision stage.

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I full agree with you, Pat. These tools are difficult even for doctors to interpret. They are aimed to help doctors make decisions, by showing patients the evidence. When non medicos try to interpret it, it’s very very difficult and they will more often than not, land up confused and lost and may not end up interpreting correctly. While reading these tools, it is assumed that one needs to have basic knowledge of both breast cancer epidemiology and how things are interpreted, especially when it related to Quality Of Life. Without that backup knowledge, trying to read it will lead to incorrect or inadequate interpretation. And in a country like India, where a majority of population has an extra ordinary staunch belief in alternate treatment and magic (I so often he t patients who feel cow’s urine can cure cancer or Yoga can cure cancer or soursop juice can cure cancer; they stay in a world of magic and believe that there is this one thing, which the medical community is hiding from them, which will fully cure cancer. And Pat, such patients are not uncommon; they are, in fact, fairly common. of course, the moment they discuss this, I refer them to tertiary Centre for treatment, I prefer not to treat them) these tools are likely to be interpreted incorrectly.

So Payal, though you have been good in reading the Predict chart; it’s utility is still extremely limited when it comes to non medicos. There would be very very few intelligent like you who would try to read this. For the rest majority, where it can end up creating immense confusion, it is best avoided and it’s betyer to let a doctor judge it or interpret it for them; that’s what Pat is trying to say. Also, it’s very important to understand that patients of same stage and same age may still have different outcomes based on certain points in their pathology report and depending on their ability of undergo further treatment. There are, in fact, so many points, that it is impossible to generalize for any stage, the chances of recurrence and survival. It is absolutely individualized. The aim of these tools is to help in times of indecision about further treatment.

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What you are looking at is Overall Survival.

It means likelihood of remaining alive at 10 years had you not taken and agreed with initial decision to undergo treatment

It does not mean probability of relapse

That is much higher than this.

So those 73.6 women, many of them have a relapse (cancer recurrence) and then undergo additional surgery, then agree for chemo, then agree for Radiation .

And God's second chance at beating the disease works in many in the US.

But many stick to their guns and would still not undergo chemo and other treatment , they would eventually suuccuumb to disease.

There is a minority of patients who would survive based on their stage (without any additional treatment)

Which ones relapse

Which ones don't...is impossible to predict as of now.

There are newer tests now available like ONCOTYPE Dx , Mammaprint, which help distinguish this based on ones individual genes..but they cost in lakhs and perhaps with time..their coat may come down.

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Thanks, I was looking for the perspective and experience on these lines. It is good to highlight that 73.6 may have cases of relapse. That information/perspective is missing from the chart. Also Quality of life in those 10 years.

Some of those minority of patients who survive (if they have taken any alternative medicine) may become false positive cases of alternative treatments.

Looking at the toxicity of the treatment and subsequent side effects, I hope new diagnosis test get more affordable and accurate quickly. To me, not all should need to go through this toxic treatment.

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New diagnostic tests and facilities are available since decades. They are very much affordable. But one has to come to a doctor for them. The problem India faces is that of an extra ordinary lack of awareness. Diagnostic tests for early detection of cancer do not help much. We do not need to depend on machines and test to help us detect cancer early. We need to depend on ourselves. For India, what matters is the time of symptoms. It is so common even in my practice today, when I ask my patients - “since when have you noticed the lump?” And the answer I get is “three months” “six months”. And at times “one year”. And trust me, when I do a PET scan for most of these patients, 90 percent of them will have stage 3 or 4 cancer. It’s indeed painful to see women sit at home for months together carrying a cancerous tumour. And trust me, almost all of them do feel something is wrong, but they still don’t report it. When they don’t report to a doctor even when they realize a problem, how likely are they to come for tests year on year when they really don’t have any symptom? you can answer this yourself. Important is to report on time. What India needs is “awareness” of symptoms of BC and not some complex tests to detect it early. We want to hear the answers as - “three days” “six days” instead of “three months” “six months”. That’s where the fight for India lies.

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