Doctors Start to Rethink Wisdom of Chemo for Breast Cancer Patients

A growingrealization that women are being vastly overtreated with toxic and dangerous drugs is prompting a widespread rethinking among doctors about the use of chemotherapy. For years chemo has been the standard treatment for anyone with breast cancer—and still is in most cases. But now that women are identifying the disease sooner and living longer, physicians are starting to notice more long-term repercussions from chemotherapy. At the same time, recent studies show that in certain patients, hormonal drugs such as tamoxifen work better.

While most side effects of chemotherapy, such as nausea and hair loss, are temporary, others are more serious. Chemotherapy can trigger early menopause. Some women develop memory loss and fuzzy thinking often called “chemo brain”. A fraction of women will develop a second cancer such as leukemia or serious heart problems as a result of the treatment. Nevertheless, chemotherapy clearly saves lives. For most women with cancer that has spread to the lymph nodes, the benefits far outweigh even the most serious risks. For women with relatively small tumors whose cancer hasn’t spread to the nodes, the decision to use chemotherapy is far more difficult.

If you take 10 such women and treat them with surgery and radiation, seven will be fine after a decade and three will have died. If you add chemotherapy, one additional woman will be saved. The problem is that we do not know if any given woman is in the group of three or the group of seven, so there is an acknowledged overtreatment of women.

Doctors are searching for markers to help them better identify the 20-30% of women who will relapse even though their cancer is caught very early. Too many copies of a gene called HER2/neu, for example, may signal a more aggressive cancer, which may be better treated with a certain type of chemo and a drug called Herceptin.

As research into other markers continues, there are some questions a woman can ask now to help decide whether to undergo chemotherapy:

·        Are you pre- or post-menopausal?  Studies show chemo is far more effective in younger women, lowering death rates by 27% in women under 50, compared to 11% in women over 50.

·        What are the alternatives?  Because 80% of breast cancers are fueled by estrogen, hormonal drugs that suppress estrogen, such as tamoxifen and Arimidex, may work just as well as chemotherapy in certain women. Another option is to suppress the body’s estrogen production, by either surgical removal of the ovaries or by blocking them with radiation or medication.

·        Is your tumor sensitive to estrogen?  Women whose cancers aren’t stimulated by estrogen (estrogen receptor negative tumors) may have the most to gain from chemotherapy. A new study published in the Journal of the National Cancer Institute questions the use of chemotherapy in women who are postmenopausal with estrogen receptor positive tumors. For them tamoxifen by itself works as well.

·        What is my absolute benefit?  Chemotherapy reduces a woman’s relative risk of recurrence by about 30%. If her risk of getting cancer again is 10%, then on average, chemotherapy will lower this risk by about a third to about 7%.