Friday, June 8, 2018

Is Chemo for Breast Cancer overprescribed?

According to a landmark study, a large percentage of individuals with the most common form of early breast cancer could safely skip chemotherapy. The findings could impact thousands of people each year.

While new therapies such as immunotherapies are becoming increasingly crucial in treating cancer, chemotherapy is still a mainstay. Though chemotherapy is effective, it carries with it a range of significant side effects, such as hair loss, increased risk of bleeding, susceptibility to infection, nausea, vomiting, and anemia. Consequently, chemotherapy is only used when deemed entirely necessary. The challenge lies in determining exactly when it is entirely necessary.

Individuals with breast cancer sometimes have their tumors analyzed using a gene test called the Oncotype DX test. This examines how active 21 specific genes are provides a “recurrence score” of 0-100. When scores are high, chemotherapy will be used following surgery or radiation therapy to lower the risk of the cancer returning. For individuals with low scores, the tumors are considered less dangerous, and chemotherapy is not deemed essential.

This type of testing has proven useful but there is a substantial gray area. As it stands, those who score 1-10 do not receive chemotherapy and those who score above 25 do. The majority of women, however, fall in the intermediate range of 11-25.

To get a better picture of who needs treatment, researchers from Loyola Medicine and Montefiore Medical Center undertook a large-scale investigation. Their findings are now published in the New England Journal of Medicine.

They used data from more than 10,000 women with hormone-receptor-positive, HER-2 negative breast cancer – the most common form of breast cancer, accounting for about half of breast cancer cases in the United States. Of particular interest were the 69% of women who had scored 11-25 on the 21-gene test.

The participants were randomly assigned into two groups. Half of them received hormone therapy and chemotherapy, and the other half received hormone therapy alone. They assessed the following outcomes: being cancer free, cancer recurrence locally or in another part of the body, and overall survival. When the study group was analyzed as a whole, there were no significant differences between the two groups.

“With [the] results of this ground-breaking study, we now can safely avoid chemotherapy in about 70% of patients who are diagnosed with the most common form of breast cancer” – Study co-author Dr. Kathy Albain.

My Take:
Don’t wait until this new research becomes the standard of medicine, avoid chemotherapy if your 21-gene test is 25 or less.

Additionally, I highly recommend a cruciferous vegetable or broccoli extract as a daily supplement as a preventative for estrogen dominant breast cancer.

If you are concerned about your risk for breast cancer, I also suggest the DUTCH hormonal profile. I have posted a few blogs about this test. One of the advantages over other forms of hormonal testing is that it measures the intermediate metabolites of estrogen – 2, 4, and 16-hydroxyestrogen. Both the 4 and 16 form are carcinogenic.

The Bottom Line:
You must all be your own health advocates. This is especially true with breast cancer. It is disheartening to see the traumatic increase in bilateral radical mastectomies after Angelina Jolie opted for this surgical procedure. Educate yourself, and if necessary, educate your physician and family.

June 4, 2018 National Institutes of Health

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