Medical Study: Untreated Cancer Patients Live Longer

[Guest guest]

Found this info on radiation and tamoxifen in one of Dr. Moss.'s newsletters.

Dr. Moss seems tp agree that radiation and drugs are of not much use

 

RADIATION ADVOCATED AFTER SURGERY FOR DCIS

 

 

 

In an article appearing in the current issue of the

Lancet (July 12, 2003), scientists report that

radiation therapy after surgery can reduce the risk of

breast cancer recurrences in women with ductal

carcinoma in situ (DCIS). DCIS is a precancer that

occurs when the cells that line the milk ducts in the

breast show cancer-like changes. It is not exactly

cancer - more like a risk factor for the disease.  The

proper treatment of this increasingly common condition

is controversial.

 

 

When DCIS is limited in scope, it may be treated by

removing the affected part of the breast

('lumpectomy'). But what then? Radiation and the

anti-estrogenic drug tamoxifen may be prescribed. If

DCIS is extensive, then a full mastectomy may be

suggested. But not all doctors are convinced that such

aggressive treatments are really necessary.

 

 

A recent clinical trial reported in the Lancet tested

several post-surgery options in over 1,000 women in

Britain, Australia and New Zealand. All of these women

first had excisional surgery and then received either

radiation therapy or tamoxifen, or both. The results

showed that radiation reduced the risk of a recurrence

of DCIS in the same breast by 60 percent and the risk

of invasive cancer (i.e., cancer which has spread

beyond the ducts) by more than 50 percent. Statistics

such as this can give a false impression of the value

of the treatment.  Actually, the chance of having a

recurrence in the affected breast decreased from 5.3

percent in the control group to 2.5 percent in the

radiotherapy group, which is an absolute risk reduction

of just 2.8 percent.

 

 

Prof. Jack Cuzick, an epidemiologist with the charity

Cancer Research UK, who led the study, has concluded

that most women should therefore get radiation therapy

for DCIS. By contrast, tamoxifen was essentially of no

use for such patients. " Radiotherapy works just as well

in the presence or absence of tamoxifen, " Cuzick told

reporters. Dr. Cuzick said that his research supported

the findings of two earlier studies that also showed

the benefits of radiation for DCIS patients.

 

 

DCIS accounts for about a quarter of all breast cancers

that are detected by mammograms. There are three grades

of the condition, low, medium and high. If left

untreated, DCIS can develop into invasive cancer, but

this does not by any means always happen. Not

surprisingly, women who have low grade DCIS are least

likely to have a recurrence. Cuzick has said that the

next clinical trial will focus on the question of

whether women who have a low risk of recurrence might

benefit from radiation therapy.

 

 

 

What Radiation Does Well

 

 

 

It should come as no surprise that radiation therapy

helps to prevent the recurrence of DCIS and breast

cancer. That is what radiation does well for many forms

of cancer. The key questions that puzzle many observers

are these: (1) Does radiation therapy actually increase

overall survival and/or enhance quality of life for

those who take it? (2) What are the long-term

costs - physical, emotional and financial - of this

treatment?

 

 

Nothing is said in the Cuzick study about the impact of

radiation on survival. The paper simply states that

just 45 (out of 1,030) patients died during the

follow-up period. For 23 of these patients, the cause

of death was breast cancer - or at least, breast cancer

was present at the time of death. Of the remaining 22

deaths, nine were attributed to cancers other than

breast, four to cardiac failure, two to vascular

events, and two to other causes. Data were missing for

five patients. It is not specified which of these

deaths occurred in the various treatment groups. " There

are too few deaths for a meaningful analysis of cause

of death by treatment, " said the authors. In any case,

the risk of dying of breast cancer after surgical

excision of DCIS is small. And one cannot say that

radiation has any impact at all on survival in this

population.

 

 

As to the cost of radiation therapy, the paper also

says nothing, and it is difficult to find reliable

data. But a 1997 Canadian study showed that the cost of

giving adjunctive radiation for breast cancer was

around $7,000 per patient (Dunscombe 2000). I don't

know what that would equal in today's US dollars, but

if we postulate that medical inflation since then

cancels out the depreciation of the Canadian dollar,

that yields the basis for a reasonable guess. Since the

American Cancer Society estimates that there will be

47,345 US cases of DCIS in 2003 (ACS 2003), this works

out to more than $331 million per year, just for the

radiation portion of the treatment. In an era of cost

cutting, this must be factored into the equation.

 

 

This well-documented study shows that radiation, when

added to limited surgery, greatly decreases the number

of recurrences of breast cancer following treatment for

DCIS. But many of these recurrences could be dealt with

by further surgery, when and if they occur. The study

does not show that radiation actually improves survival

from this pre-cancerous condition. Nor does it show

that tamoxifen is of any benefit, either alone or

combined with radiation, in treating this stage of the

disease.

 

 

I worry about the long-term health effects of radiation

therapy. We know, for instance, that in earlier studies

of breast cancer, unexpected long-term damage to the

cardiovascular and immune systems vitiated any

immediately beneficial impact of radiation. Radiation

is also a " perfect carcinogen, " which can both initiate

and promote tumor formation. For that reason, I would

not be so quick to make adjunctive radiation part of

the standard protocol for this precancerous condition.