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A new study has the potential to make breast cancer treatment easier for a sizable number of women, the New York Times reports. The study says the removal of lymph nodes from the armpita common, painful procedure that carries side effects of its ownisn't necessary for about 20% of patients in early stages of the disease. "The discovery turns standard medical practice on its head," declares the Times.
This is such a radical change in thought that its been hard for many people to get their heads around it, says a doctor at Sloan-Kettering and an author of the study. The hospital has already changed its treatment procedures accordingly. The full study, published in the Journal of American Medicine, is here.
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The researchers, who looked at almost 3,000 women, also found outcomes were the same whatever kind of treatment women had - including mastectomies. Experts say it means women can take time to decide if the radical surgery is right for them. The study did not look at preventative mastectomies. These are offered to women with faulty genes to cut their risk of developing cancer. Mutations in the BRCA1 and BRCA2 genes increase a woman's risk of breast cancer by four-to-eightfold and can explain why some families have lots of relatives diagnosed with breast cancer. The study, published in The Lancet Oncology, found 12% of 2,733 women aged 18 to 40 treated for breast cancer at 127 hospitals across the UK between 2000 and 2008 had a BRCA mutation.
Young woman gets breasts checked
The women's medical records were tracked for up to 10 years. During this time, 651 of the women died from breast cancer, and those with the BRCA mutation were equally likely to have survived at the two-, five- and 10-year mark as those without the genetic mutation. This was not affected by the women's body mass index or ethnicity. About a third of those with the BRCA mutation had a double mastectomy to remove both breasts after being diagnosed with cancer. This surgery did not appear to improve their chances of survival at the 10-year mark. But the researchers said surgery may still be beneficial for these patients to reduce their risk of a new cancer developing in the longer term.
What is the BRCA gene?
It has been dubbed the 'Angelina Jolie gene', after the actress revealed she underwent preventative surgery on learning she had an up to 87% chance of developing breast cancer. Everyone has the BRCA genes, but when a fault occurs in one of them it can result in DNA damage and lead to cells becoming cancerous. Around 1 in 800 women in the general population are thought to carry the mutation and 5% of women with breast cancer in the UK will have a faulty form of the BRCA gene. The faulty genes are also linked to an increased risk of ovarian and prostate cancers, as well as breast cancer.
Angelina Jolie had a double mastectomy, and her ovaries and fallopian tubes removed
Angelina Jolie had a preventative mastectomy, before she developed cancer. These types of surgery were not examined in this study. The study's author, Professor Diana Eccles, of the University of Southampton, said: "Women diagnosed with early breast cancer who carry a BRCA mutation are often offered double mastectomies soon after their diagnosis or chemotherapy treatment. "However, our findings suggest that this surgery does not have to be immediately undertaken along with the other treatment."
'More time to decide'
It's good news, but it comes nearly two decades after the drug first went on the market and many patients have suffered that side effect. The study was done in the United Kingdom and funded by UK government grants. Results were released Wednesday by the American Society of Clinical Oncology and will be presented at the group's meeting next month. Herceptin transformed care of a dreaded disease when it was approved in 1998 for women with advanced breast cancers whose growth is aided by a faulty HER2 gene, as 15 percent to 20 percent of cases are. It was later approved for treatment of those cancers in earlier stages, too, based on studies that had tested it in patients for 12 months. That guess, that the drug should be taken for a year, became the standard of care.
A radiologist uses a magnifying glass to check mammograms for breast cancer in Los Angeles, California
But the drug can hurt the heart's ability to pump. That often eases if treatment is stopped but the damage can be permanent and lead to heart failure. Some studies tested shorter use, but results conflicted. The new study is the largest so far, and involved more than 4,000 women with early-stage cancers who were given usual chemotherapy plus Herceptin for either six or 12 months. After four years, about 90 percent of both groups were alive without signs of the disease. Only 4 percent on the shorter treatment dropped out due to heart problems versus 8 percent of those treated for a year. “It's great news” for patients, said the study leader, Dr. Helena Earl of the University of Cambridge in England. Earl has consulted for Herceptin's maker, Roche. The company had no role in the study.
Compelling findings
“There's no reason to not immediately change practice. The findings are persuasive,” said Dr. Richard Schilsky, chief medical officer for the oncology society. Most of Herceptin's cancer-fighting benefit seems to come in the early months of use, he said. Others said that because so few women have died or relapsed after being treated with the drug, longer followup may be needed to make sure the findings hold up before guidelines should be changed. Doctors also want to see results published, and to study them to see if certain groups of women need longer treatment. Herceptin is given through an IV every three weeks; a year of it costs $34,000 to $40,000 in England and about $70,000 in the U.S. In December, a copycat competitor known as a biosimilar was approved in the U.S. and already is used in some other countries. Dr. Harold Burstein, a breast cancer expert at Dana-Farber Cancer Institute in Boston, said shorter treatment may increase access to the drug in countries where many women can't afford it now, but that in the U.S., “my guess is that people will continue to aim for a year of treatment” because of lingering concerns that longer use is better, as a smaller, previous study suggested.
Chemotherapy drugs are administered to a patient at North Carolina Cancer Hospital in Chapel Hill, North Carolina, May 25, 2017. Health experts are stepping up warnings as more cardiac side effects of some breast cancer treatments come to light.
Dr. Jennifer Litton, a breast specialist at MD Anderson Cancer Center in Houston, said Herceptin was a true breakthrough, but scaling back treatment whenever possible is just as important to patients. She said the results show how important it can be to study drugs already on the market, and that drug companies alone should not be relied on to do studies like this. “It's really important that we continue to have public funding for trials so we can continue to ask all of these questions for our patients,” she said. Herceptin's developer, Genentech, now part of Roche, said in a statement that the new study must be viewed along with several smaller previous ones that found one year to be best. The goal of treatment “is to provide people with the best chance for a cure,” so women need to talk with their doctors about how best to reach that goal, the statement says. Earlier this year, the American Heart Association issued its first statement on the heart effects of cancer drugs, saying women should consider carefully the risks and benefits of any therapies that may hurt hearts.
Shorter Drug Treatment OK for Many Breast Cancer Patients
