Doctors who treat women with breast cancer are glimpsing the possibility of a vastly different future.
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% of women whose breast cancer is not fuelled by estrogen.
So far the data are tantalising, but the evidence is very new and still in flux. And even if some women with hormone-dependent tumors can skip chemotherapy, no one can yet say for sure which women they might be. Some doctors have already cut back on chemotherapy, but the advice a woman gets often depends on which doctor she sees. It could be a decade before the new studies - one American, one European - provide any answers.
"It's a slightly uncomfortable time," said 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 John H Glick, director of the Abramson Cancer Center of the University of Pennsylvania. 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 randomised 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," Glick said. For women with breast cancer, of course, the uncertainty is excruciating. They are now confronted with differing opinions. NYT News Service