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Chemotherapy in breast cancer is often superfluous

A woman undergoes mammography as part of breast cancer screening. (Archive)

Nausea, Fatigue, Hair Loss: Previously, many breast cancer patients had no alternative to chemotherapy. Today, doctors scare more and more women away from it. A new investigation shows them right.

Most women with the most common form of early breast cancer can refrain from chemotherapy, according to a new study. The chance of conquering the disease is not diminished, as revealed by the doctors landmark survey. The study evaluated each patient's risk by using genetic testing.

"The effect is huge," says study manager Joseph Sparana from Montefiore Medical Center in New York. Most women in this situation need no other treatment than surgery and hormone treatment, and chemo is unnecessary. The study, the most recent analysis of breast cancer treatment, could save up to 70,000 patients in the United States solely from the hardness and cost of chemotherapy. There are many more women around the world.

The study was funded by the American National Cancer Institute and several foundations. The findings were discussed on Sunday at a conference hosted by the American Society of Clinical Oncologists in Chicago and published in the New England Journal of Medicine Journal. Some of the study leaders recommend drug companies that manufacture breast cancer drugs or genetic testing companies.

Away from Chemotherapy

Over the years, cancer treatment has been removed from chemotherapy on older drugs severe side effects. Instead, doctors often prefer gene therapy, hormone blockers and immune systems. When chemotherapy is used today, duration and dose are often lower than before.

The study focused on early stage cases where the benefits of chemotherapy increasingly concern: women whose breast cancer does not affect the lymph nodes that are hormone receptor positive – the growth is thus driven by estrogen or progesterone – and does not correspond to the form treated with the drug Herceptin.

The usual procedure here is surgery followed by years of antihormone treatment. However, many women are also advised to undergo chemotherapy to kill potential proliferative cells. Doctors are aware that most patients do not need chemo. But little is known about who can do without it.

In the new study, a total of 10,273 patients underwent a genetic test called Oncotype DX. It uses a tissue test to measure the activity of genes involved in cell growth and the response to hormone treatment. In this way, the risk of recurrence of cancer was estimated.

Results of the Study

About 17 percent of women had a high risk profile and were recommended to undergo chemotherapy. The 16 percent with a low risk factor now know that they can refrain from chemotherapy, as evidenced by previously published results of the study.

The new results affect 67 percent of middle risk patients. All were operated on and treated with hormone therapy, half of them with chemo. After nine years, 94 percent of both groups still live, and 84 percent have no signs of cancer. The extra chemotherapy made no difference.

Some women aged 50 years or younger benefited from chemotherapy. Here, a slightly lower proportion of patients showed that cancer spreads far beyond the breasts.

Are the results credible?

All women with similar disease profile for the study should undergo a genetic test to determine the correct treatment, says Richard Schilsky, senior oncology US physician company ASCO. The Oncotype DX test costs about $ 4000 (3950 francs). Similar tests, including one called MammaPrint, are often used.

The tests have solved the major problem of identifying who needs chemotherapy, explains Harold Burstein from the Dana-Farber Cancer Institute in Boston. Many women are of the opinion that "if I do not get chemotherapy, I will die, and if I get chemotherapy, I'll be cured." However, the results showed that the benefits on the scale fluctuated and sometimes it was no benefit, he explains.

North Carolina Breast Cancer Specialist Lisa Carey says she would discourage chemo patients in good conscience when they had the same profile as those in the study who did not suffer from this treatment. Her colleague Jennifer Litton of the MD Anderson Cancer Center in Houston agrees, but stresses that each patient is dealing with another risk.

The 78-year-old Adine Usher from Hartsdale, New York, participated in the study ten years ago at Montefiore Center and was randomly assigned to the chemotherapy group. "I was a bit relieved," she reminds. "I considered Chemo somehow extra insurance."

The treatment was stressful: Her hair fell out, she got an infection and had to spend a few days in the hospital due to a poor blood count. "But it was over quite fast, and I was really glad I got it," says Usher. If a doctor had recommended that she give up chemotherapy based on genetic testing, "I would be stuck with it," she explains. "I trust medical research."

Adine Usher, 78, talks to the head of the breast cancer study in New York, Dr. Joseph Sparano.

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