If your breast cancer is caught early, what type of treatment is best to follow? Is surgery to remove the tumor enough? Or should you undergo chemotherapy as well? These are the questions that breast cancer patients and their doctors are facing when the disease is found in the earliest stages.
Forbes reports that seven out of ten women diagnosed with breast cancer are in the midst of early-stage cancer, which means the risk of recurrence is small. However, small does not mean absent or even insignificant. As such, many women spent decades undergoing chemotherapy after a lumpectomy to remove any chance of the cancer recurring or spreading throughout the body.
Today, there are a few different mechanisms by which oncologists help their patients decide whether to undergo chemotherapy. The size of the tumor as well as how it reacts to certain hormones like estrogen or progestin help doctors analyze the risk of breast cancer recurrence.
More recently, some scientists have looked at the DNA of breast tumors both in the circulating blood and the tumor tissue itself. Back in 2007, the MammaPrint was developed in the Netherlands and passed FDA clearance to classify tumors based on the activity of 70 genes associated with the breast cancer a woman was diagnosed with.
The researcher Laura van’t Veer, director of applied genomics at the University of California, San Francisco, is using the MammaPrint technology to study nearly 7,000 women diagnosed with early-stage breast cancer at more than 100 cancer research centers in Europe.
The research involves putting some women in a chemotherapy treatment program and other women on a treatment path lacking chemotherapy. The results showed that nearly the same percentage of women with high clinical risk and low genomic risk who hadn’t received chemotherapy were alive after five years without any distant spread of their cancer as compared to women who had received chemo treatment. The percentage difference was at 1.5 percent, but may have been due to chance.
“These findings provide evidence that the genomic test can reassign some classically high-risk patients with early-stage breast cancer to a lower-risk cohort in whom any plausible chemotherapy benefit would be modest,” Dr. Clifford Hudis of Memorial Sloan Kettering Cancer Center and Dr. Maura Dickler of Weill Cornell Medical College wrote in an editorial. “However, a difference of 1.5 percentage points, if real, might mean more to one patient than to another.”
Patients clearly can make their own decisions regarding whether this slightly elevated risk is worth undergoing chemotherapy, but Dr. Vered Stearns advises that a survival benefit of 1 to 2 percent isn’t worth undergoing chemotherapy due to the risks already present with this type of treatment.
“Up to now, we have not used the MammaPrint test,” she said. “We really were waiting for this fully published article. Now we have to talk about it. I do think having tools to better understand the biology of the cancer and the risks of the individual is very important.”
The future of breast cancer treatment will clearly be more involved in personalizing therapies to each individual patient. Utilizing genetics in analyzing women’s breast cancer risks will also bring more benefit and potentially increase the number of lives saved from this disease.