Most women with early-stage breast cancer may be able to avoid chemotherapy, a new study finds.
Researchers determined that patients with smaller-sized tumors that had not spread to the lymph nodes did just as well without chemo as those who got the treatment, according to the study presented Sunday at the American Society of Clinical Oncology meeting and published in the New England Journal of Medicine.
Experts cautioned, however, that the findings may not apply to those who have larger tumors or those with cancer that has started to spread, or metastasize. More studies are needed to look at those groups of women, they said.
“This is a really big deal,” said Dr. Adam Brusky, a coauthor on the new study and a professor of medicine at the University of Pittsburgh. The bottom line, Brusky said, is that doctors now have a test to determine which early-stage patients — and that’s most of them — can skip chemotherapy.
Of the more than 250,000 women in the U.S. expected to be diagnosed with breast cancer, the new findings could benefit more than 63,000 with non-invasive, or early stage, disease.
Women with cancer are given scores that come from genetic tests that analyze the tumors and look for the presence of 21 genes that have been associated with a high likelihood of recurrence. Until now, doctors didn’t know for sure whether to offer chemotherapy to a large percentage of patients with early stage cancer.
The new study, dubbed the TAILORx trial, followed 9,717 women with early-stage disease, ages 18 to 75, with estrogen-receptor-positive, HER2-negative cancers that had not spread to the lymph nodes — cases where doctors have been unsure whether chemo would be helpful.
Of the 9,717 women, 6,711, or 67 percent, had test scores indicating an intermediate risk of recurrence — their score was 11 to 25. After surgery and radiation, those women were randomly assigned to receive chemotherapy with an estrogen-blocking medication or just the estrogen hormone blocker.
10 celebrities get real about breast cancer
10 celebrities get real about breast cancer
The 56-year-old was most recently diagnosed with breast cancer soon after the 2017 Emmy Awards. She confirmed the diagnosis on Instagram, quickly calling attention to the plight of other women who don't have health care.
"1 in 8 women get breast cancer. Today, I'm the one. The good news is that I have the most glorious group of supportive and caring family and friends, and fantastic insurance through my union. The bad news is that not all women are so lucky, so let's fight all cancers and make universal health care a reality," she wrote in the post.
In 2013, at age 37, the actress wrote a New York Times piece about her experiences with breast cancer and the BRCA1 gene. She had an 87% risk of breast cancer, 50% risk of ovarian cancer, so she took preventative action, including a double mastectomy and the later removal of her ovaries and fallopian tubes.
"Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex," she wrote.
Continuing in the New York Times, But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.
At 40, the acclaimed actress was diagnosed with breast cancer after a routine mammogram in 2006. She decided to keep it private for a year after her diagnosis.
At age 12, Nixon watched her mother battle breast cancer and knew the importance of preventative care.
"I’ve learned that if you catch breast cancer early, the chances are overwhelmingly good that you’ll be cured. So my attitude, which very much mirrored my mother’s, was this wasn’t a big deal," the star said, according to Marie Claire.
In 2011, after the diagnosis of an early-stage tumor, the host underwent a double mastectomy and reconstructive surgery.
She said to Glamour: "....My doctor said, "We have great news in one breast and bad news in the other. You need to start thinking about a mastectomy." That had been the furthest thing from my mind. I knew nothing about breast cancer before this happened to me, and I thought mastectomy meant stage three or four cancer. I didn't have a big family history of it. I just never thought it would happen to me. I really didn't."
The former "Beverly Hills, 90210" star was diagnosed in 2015 and regularly documented her battle on social media. After going through chemotherapy, she announced she's in remission in April 2017.
"Moments. They happen. Today was and is a moment. What does remission mean? I heard that word and have no idea how to react. Good news? YES. Overwhelming. YES. Now more waiting. As every single one of my fellow cancer family knows, the next five years is crucial. Reoccurrences happen all the time," she shared on social media.
In 2006, the singer publicly announced she was battling the disease after she underwent "minimally invasive surgery."
"I am inspired by the brave women who have faced this battle before me and grateful for the support of family and friends," she said according to ABC News.
In 2017, the 68-year-old singer and actress revealed she was once again battling breast cancer. After her first diagnosis in 1992, she underwent a partial mastectomy as well as chemo.
"I am really grateful for and touched by the worldwide outpouring of love and concern. Thank you. I am feeling good and enjoying total support from my family and friends, along with a team of wellness and medical practitioners both here in the US and at my Olivia Newton-John Cancer Wellness and Research Centre in Melbourne, Australia. I’m totally confident that my new journey will have a positive success story to inspire others!” she said exclusively to People in June.
Because of the singer's family history, Etheridge was "vigilant" about examinations before eventually being diagnosed in 2004.
"I am the healthiest I have ever been in my life. It excites me every day when I can wake up and feel energy and feel good and feel purpose. The changes I made were big and not easy. Sugar is a drug, incredibly addictive. That one change can make a huge difference in your life," she said to ABC News in 2015.
At 36 years old, the actress was diagnosed with breast cancer in 2008. After biopsies and a lumpectomy, as well as radiation, she tested positive for the BRCA gene.
Later, she underwent a double mastectomy. "It came on really fast. It was one of those things that I woke up and it felt so right," she says. "It just seemed like, 'I don't want to have to deal with this again. I don't want to keep putting that stuff in my body. I just want to be done with this.' & I was just going to let them go," she said according to CNN.
In 2015, it became known that the actress was battling breast cancer and underwent both a double mastectomy and reconstructive surgery.
Since then, she's been outspoken about encouraging others to be vigilant about routine checks.
"Last week, with my husband by my side, and with the love and support of family and friends, I underwent a bilateral mastectomy and reconstruction for breast cancer after a diagnosis of invasive lobular carcinoma. I am recovering and most importantly, expected to make a full recovery. Why? Because I caught this early, have excellent doctors and because I got a second opinion," she said according to People.
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Prior to the study, doctors knew women with a low score on the test, less than 11, were told they could skip chemo with no ill effects. Women at high risk, or scores of 26 or higher, were advised to have chemo.
The new study showed that women with intermediate risk, it made no difference in terms of recurrence whether a woman was treated with chemotherapy or not.
“We didn’t know if chemotherapy benefited women in this range," said Dr. Sara Hurvitz, an associate professor at the University of California, Los Angeles, and director of breast medical oncology at the UCLA/Jonsson Comprehensive Cancer Center. "The study showed that if you take the group as a whole, there is no difference in the risk of recurrence when you compare chemotherapy to no chemotherapy.”
Nine years after their initial treatment 83.3 percent of women treated with just an anti-estrogen medication and 84.3 percent in the anti-estrogen plus chemotherapy group were cancer free. Further, 94.5 percent of those treated with just an estrogen blocker and 95 percent of those treated with anti-estrogen plus chemo, had no recurrence at a distant site.
Some cancer specialists have been postponing the decision to treat their newer patients with chemotherapy until the study findings were released.
“Last week, with the data release being imminent, we decided to hold off,” said Dr. William Gradishar, a professor of medicine and chief of hematology and oncology at Northwestern University’s Feinberg School of Medicine. “This will significantly impact the way we approach things. These kinds of tools allow us to make tailored medicine a reality, allowing us to offer the right therapy for the right patient at the right time.”
WHY IS IT BETTER TO AVOID CHEMO?
Avoiding chemotherapy can make a major difference to a woman's quality of life and health. The treatment can cause unpleasant side effects, some of which can put a woman’s life at risk. Along with hair loss, nausea and vomiting, chemo can leave a woman with a depressed immune system, said Dr. Jennifer Litton, an oncologist and an associate professor at the University of Texas MD Anderson Cancer Center.
Long-term, Litton said, it can leave a woman with permanent numbness and tingling.
For Litton, the new study will make a tremendous difference in breast cancer treatment for many women. "We now can identify a larger group of women who can avoid chemotherapy and just give anti-estrogen therapy and get the same results,” she said.
The new findings offer reassurance to patients like 61-year-old Debra Reese of Houston, whose score of 10 led her doctor to recommend against chemotherapy.
“I think I fall right in line with the study and the results that came out from it,” Reese said. Knowing the results the new study, she is reassured, "I did the right thing."