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Chemotherapy for Breast Cancer Depends on Patient’s Situation (dateline March 13, 2000)

Researchers presented study results at the 17th annual Miami Breast Cancer Conference that revealed that while chemotherapy is useful in helping reduce the size of a breast tumor so that breast conserving surgery (lumpectomy) may be performed, it is usually not an effective treatment on its own. Another study reported that physicians should calculate a patient’s risk of breast cancer recurrence (return) in deciding whether to prescribe chemotherapy after breast cancer surgery.

The first study, led by Dr. Umberto Veronesi, MD of the European Institute of Oncology in Milan, Italy, showed that chemotherapy is very effective on primary breast tumors but is less effective on distant tumors. Over 80% of breast cancer cases can be treated with breast conserving surgery ( lumpectomy) instead of mastectomy (breast removal) if chemotherapy is given prior to surgery. Chemotherapy may also reduce the size of a large tumor so that it may be operable with mastectomy. Regardless of the chemotherapy regimen, the treatment is useful in reducing the size of primary breast tumors, said Dr. Veronesi. Chemotherapy given prior to breast cancer surgery is called neoadjuvant chemotherapy.

However, Dr. Umberto noted that patients who are treated with chemotherapy alone or chemotherapy followed by radiation therapy do not typically experience a complete cure of their breast cancer or improve their chances of survival compared with patients who receive chemotherapy after breast cancer surgery.

Another study presented at the Miami Breast Cancer Conference showed that the decision to give breast cancer patients chemotherapy should depend on their risk of cancer recurrence (return). Dr. Michael P. Osborne, MD, of the Strang-Cornell Breast Center in New York said that axillary (underarm) lymph node status was a key factor in determining additional breast cancer treatment after breast surgery. Patients whose cancers have spread to the axillary lymph nodes may benefit from receiving chemotherapy after breast cancer surgery.

A poor grade of breast cancer (as determined by a pathologist) also helps predict a patient’s risk of recurrence, according to the study. Breast cancer patients who did not show cancer in their lymph nodes but whose cancers were given a poor nuclear grade were less likely to remain cancer-free after seven years compared with patients whose cancers were not assigned poor grades in the lab. Thus, patients with poor grade cancers may benefit from receiving chemotherapy after breast cancer surgery. Chemotherapy given in addition to breast surgery is called adjuvant chemotherapy.

Interestingly, Dr. Osborne said the risk of breast cancer recurrence cannot be determined by examining the presence of the HER2 protein receptors or estrogen or progesterone receptors on breast tumors. While these factors may help physicians evaluate treatment, they are not reliable in predicting a patient’s prognosis (expected outcome). However, previous studies have shown that patients with estrogen or progesterone receptors on their breast tumors tend to respond well to chemotherapy. Advanced breast cancer patients who have excess HER2 protein receptors on their breast tumors may be candidates for treatment with the drug, Herceptin.

Dr. Osborne told the Miami conference audience that a patient’s level of risk for breast cancer recurrence will help a physician determine whether chemotherapy may be helpful. Ultimately, the patient and the physician should discuss the risk of recurrence and determine together whether chemotherapy is needed.

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