Curbing Breast Surgeries / Study: Chemo first cuts need forprocedures
In what some researchers think is the first step toward the day when
breast cancer will be treated without surgery, doctors in Texas have
found that tumor-shrinking chemotherapy can significantly reduce the
need for debilitating operations.
For years doctors have resorted to modified-radical mastectomies
when women were diagnosed with breast cancer and also had evidence of
the disease in lymph nodes under the arm.
Now, in a study conducted by researchers at M.D. Anderson Cancer
Center in Houston, doctors have found that treating patients first with
chemotherapy, dramatically reduces the need for radical surgery.
Writing in the Journal of Clinical Oncology, the Texas team found
that an approach known as "neoadjuvant chemotherapy" was key to
preventing the tumor's spread. And once tumors were reduced in size, a
majority of the 372 patients in the study underwent lumpectomies,
avoiding radical surgery. In 43 patients, the cancer disappeared.
Neoadjuvant chemotherapy is an old line approach with new
possibilities, reports the team that studied the women. The approach
usually is recommended for patients with advanced inoperable breast
cancer in an attempt to shrink the tumor's mass. Also, traditionally,
chemotherapy is administered after surgery.
By turning the tables and using it first, doctors found that most
patients required only lumpectomies; others could be treated withoutsurgery.
"What we're saying here is that you can take that approach first,"
even in patients who show no evidence of cancer in the lymph nodes, said
Dr. Eva Singletary, chief of the surgical breast service at M.D.
Anderson and a lead author of the study.
"By giving chemotherapy up front, about 80 percent of patients had
tumors shrink by half the size and 12 percent of patients had their
tumors go completely away."
Even with such dramatic results Singletary cautioned that
neoadjuvant chemotherapy does not totally eliminate a woman's risk of
cancer recurrence, but her chances of survival are greatly improved.
Conducted between 1989 and 1996, the study involved two clinical
trials, which included women who had not previously undergone
breast-cancer surgery. The patients, whose median age was 47, received
chemotherapy during four months.
Dr. Henry Kuerer, a member of the team, said neoadjuvant
chemotherapy has many advantages.
"We can not only shrink the tumor and allow for less radical
surgical procedures, but we can also determine within three to four
months whether or not a patient responded to the chemotherapy that was
given," Kuerer said. When women don't respond, he said, doctors can
proceed with surgery.
The Texas doctors used doxirubicin, which has long proved reliable
in shrinking tumors.
Going into the study, Singletary and her team hypothesized that
significantly more patients could benefit from lumpectomy. The reality
was that modified-radical mastectomies often are performed as the
treatment of choice when tests prove the disease has advanced beyond the
"We eventually would like to replace lumpectomy with something less
invasive," Singletary said. "Putting a radiofrequency probe inside the
tumor is one way. The probe heats up the tumor and destroys it.
Currently, that has been used to destroy tumors in the liver, those that
have spread from the colon. But why not try it in breast cancer?"
Researchers at Columbia University in Manhattan, reporting in the
same issue of the Journal of Clinical Oncology, are recommending that
Ashkenazi Jewish women consider genetic screening for BRCA-1 and BRCA-2,
mutations linked to breast cancer. Less than 3 percent of Ashkenazi
Jewish women carry the gene mutations. The article also suggests that
prophylactic mastectomy - removing healthy breasts - can enhance
chances of survival. The report also recommends prophylactic
oophorectomy (ovary removal) for women carrying the BRCA-2 mutation,
which is linked to breast and ovarian cancers.
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