Is chemotherapy necessary in breast cancer?

[Guest guest]

May 12, 2006 Shift in Treating Breast Cancer Is Under Debate By GINA KOLATA http://www.nytimes.com/2006/05/12/health/12chemo.html?_r=1 & hp & ex=1147492800 & en=e7ed68c83a4d6218 & ei=5094 & partner=homepage & oref=login EXCERPTS FROM A LONG ARTICLE Doctors who treat women with breast cancer are glimpsing the possibility of a vastly different future. After years of adding more and more to the regimen — more drugs, shorter intervals between chemotherapy sessions, higher doses, longer periods of a harsh therapy — they are now wondering whether many women could skip chemotherapy altogether. If the new ideas, supported by a recent report, are validated by large studies like two that are just beginning, the treatment of breast cancer will markedly change. Today, national guidelines call for giving chemotherapy to almost all of the nearly 200,000 women a year whose illness is diagnosed as breast cancer. In the new approach, chemotherapy would be mostly for the 30 percent of women whose breast cancer is not fueled by estrogen. "It's a slightly uncomfortable time," said Dr. Eric P. Winer, who directs the breast oncology center at the Dana-Farber Cancer Institute in Boston. "Some of us feel like we have enough information to start backing off on chemotherapy in selected patients, and others are less convinced." Among the less convinced is Dr. John H. Glick, director of the Abramson Cancer Center of the University of Pennsylvania. Dr. Glick tells his patients about the new data but does not suggest they skip chemotherapy. After all, he notes, the national guidelines

were based on results from large randomized clinical trials. And the recent data indicating that some women can skip chemotherapy are based on an after-the-fact analysis of selected clinical trials. "We're in an era where evidence-based medicine should govern practice," Dr. Glick said. For women with breast cancer, of course, the uncertainty is excruciating. Faced with a disease that already causes indecision and anxiety, they are now confronted with incomplete data, differing opinions from different doctors and a choice that can seem almost impossible: Should they give up a taxing treatment when all the answers are not in and they have what may be a fatal disease? "If the medical profession is not even close to being of one mind, how is the woman to know?" said Donald A. Berry, a statistician at the University of Texas M. D. Anderson Cancer Center, the lead author of a recent

paper questioning chemotherapy's benefits in many women. Barbara Brenner, who has had breast cancer and is executive director of the advocacy group Breast Cancer Action, said, "There's a real problem," and added, "We finally tell people at the end of the day: 'You're going to get a lot of information. Trust your gut. Nobody has the answers.' " Doctors worry, too. It took two years before the National Cancer Institute and its researchers could even agree on a design for the large new American study that will test the idea that many women might safely forgo chemotherapy. The study, which starts enrolling patients at the end of this month, will involve women whose cancers are fueled by estrogen and have not spread beyond the breast. They will be randomly assigned to have the standard treatment — chemotherapy followed by a drug like tamoxifen that starves tumors of estrogen — or to

skip chemotherapy and have treatment only with a drug like tamoxifen. Copyright 2006 The New York Times Company "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." - Aurobindo.

Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Messenger with Voice.

[Guest guest]

Some Breast Cancers May Not Need Chemo

 

 

Lobular Breast Cancer Patients Live Longer Despite Poor Response to Chemotherapy WebMD

December 29, 2004

 

 

Dec. 29, 2004 -- A bad response to chemotherapy doesn't always mean a bad outcome, new research shows.

 

The first of its kind, the study shows that women with lobular breast cancer often respond poorly to chemotherapy. Yet in the study, these women had better survival rates than women with a more common type of breast cancer who respond well to chemotherapy, researchers say.

 

 

" We always have thought that a poor response to chemotherapy indicated a worse prognosis, but that is not true for every woman with breast cancer, " says the study's lead researcher, Massimo Cristofanilli, MD, a breast oncologist at The University of Texas M.D. Anderson Cancer Center in Houston, in a news release. Having a poor response to chemotherapy means that despite chemotherapy, breast cancer cells were still found in the breast or lymph nodes.

 

This " striking finding " means that women with lobular breast cancer may not need chemotherapy before surgery, he says.

 

The most common type of invasive breast cancer is ductal, accounting for almost 80% of breast cancers. Lobular breast cancers account for almost 15%.

 

Cristofanilli's study appears in this month's issue of the Journal of Clinical Oncology.

 

Breast Cancer Treatment Success

 

In their study, Cristofanilli and his colleagues analyzed medical records from six breast cancer studies. The 1,034 women in the studies had locally advanced breast cancer -- either the lobular form or the more common ductal form, which involves the milk ducts. All the women had been treated with chemotherapy to shrink their tumours before surgery.

 

 

Researchers found that women with invasive lobular breast cancer had a poorer response to chemotherapy, yet they had better overall survival rates.

 

 

41% of lobular breast cancer patients were left with breast cancer within the lymph nodes after chemo, yet 80% were cancer-free five years after treatment.

 

26% of the ductal breast cancer patients still had evidence of breast cancer in the lymph nodes after chemo, but only 72% were cancer-free five years after treatment.

 

Oncologists may change their approach to treating lobular cancer patients, he says. Therapies using hormones called aromatase inhibitors may be the better approach.

 

" Before this study, I don't think anyone realized the disease should be treated differently, " says Cristofanilli.

 

" In the end, our study indicates that chemotherapy, with its toxic effects, may not be the best standard of care for women with invasive lobular carcinoma, " he says.

[Guest guest]

Many cancers are not cancersMy Friends mom was diagnosed with Pancreatic cancer, she could nottake the medical stresses for the operation and got heart attack, so shewas operated for heart bypass surgery. That had finished her strengthso she refused the Pancrea operation.After few month her pancrea cancer had vanished in the CT scan, thedoctors said it must have been some lump. So people are treated forcancer based on suspections of cancers ?kesava pillai <kesava.pillai wrote: Some Breast Cancers May Not Need Chemo