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Not All Breast Cancer Patients Need Chemotherapy

Two recent studies took a look at whether or not chemotherapy is the best treatment for breast cancer — with interesting results.

The studies were reported at the 31st Annual San Antonio Breast Cancer Symposium, an annual gathering of scientists from around the world.

  • One study found that women were less likely to have a relapse or die if treated with a less harsh drug than the standard chemotherapy drug, Adriamycin.
  • One study (from Loyola University in Chicago, IL) used a gene test to help predict whether or not a woman actually needs chemotherapy to treat breast cancer — or breast cancer that has spread to the lymph nodes.

Only a small group of women with breast cancer will actually benefit from chemotherapy, according to these studies. Will this create a change in how doctors treat breast cancer? Almost certainly, according to medical professionals who attended the symposium.

The gene test especially has the potential to change traditional practices quickly. Oncotype DX measures the activity of twenty-one genes and predicts the risk of breast cancer recurrence. It has been in use for years with women in early stages of breast cancer.

The Loyola University study found that the Oncotype DX test could accurately predict the benefits of chemotherapy for women with breast cancer that had spread to the lymph nodes. Women with low scores generally don’t benefit from chemotherapy; women with high scores respond well to chemotherapy. Independent experts agree on the value of the gene test.

In the study, approximately forty percent of women had low scores. This translates into approximately eighteen thousand women each year who may not need chemotherapy to treat their breast cancer. Around forty-five thousand women annually fight breast cancer that has spread to the lymph nodes — a condition that is traditionally treated with aggressive chemotherapy.

The downsides:

  • The gene test is expensive — more than three thousand dollars.
  • Many doctors are hesitant to give up on a treatment (aggressive chemotherapy) that can give many patients a fighting chance.

The upsides:

  • Many insurers are willing to pay for the test — especially because it can save them from paying for chemotherapy in the long run.
  • Milder chemotherapy drugs are undergoing testing. They may replace aggressive Adriamycin and its dangerous side effects (like an increased risk of heart problems).