The People's Perspective on Medicine

Can You Skip Chemotherapy for Breast Cancer?

A study shows that women over 50 with a common type of breast cancer and an intermediate score on a genetic test could skip chemotherapy and just take anti-estrogen drugs.

Some women with the most common type of breast cancer might safely skip chemotherapy. That’s the finding from a study presented at the American Society of Clinical Oncology meeting and published in the New England Journal of Medicine (Sparano et al, NEJM, June 3, 2018).

Which Women Might Safely Skip Chemotherapy?

Doctors have long known that some women diagnosed with breast cancer do well even if they don’t undergo chemotherapy. But they haven’t known how to identify those patients who could safely skip chemotherapy.

In this trial dubbed TAILORX, scientists conducted genetic testing (using the Oncotype DX test) on the tumors of more than 10,000 women. More than 6,000 of them had risk scores in the intermediate range between 11 and 25. All of the women in the study had tumors driven by estrogen and without the tumor protein HER2. Doctors could not detect any signs of breast cancer in their lymph nodes.

The Two Treatment Groups:

The investigators randomly assigned these volunteers to get anti-estrogen treatment alone (adjuvant endocrine therapy) or chemotherapy plus tamoxifen or other hormone blockers (chemoendocrine therapy). Women older than 50 and other women who scored 15 or less on the Oncotype DX test did as well with just hormone therapy as with chemo plus hormone therapy.

According to the investigators:

“At 9 years, the two treatment groups had similar rates of invasive disease–free survival…and overall survival (93.9% and 93.8%).”

These findings buttress previous findings that pointed in the same direction. Perhaps as many as 70,000 women in the US each year could skip chemotherapy treatment and its complications without compromising their survival.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I hope they will continue to follow these women longer than 9 years. I once heard that only after 20 years can you consider yourself free and clear of breast cancer.

I reached that 20-year mark last year. I had estrogen-positive, HER-2 negative, stage 1 breast cancer. Since I had four (yes!) tumors in one breast, I had a mastectomy. I did Tamoxifen for 5 years but no chemo. My diagnosis and surgery were before the genetic tests were available.

Had DCIS breast cancer at age 42; elected to do removal; clear margins, radiation, and arimidex, 15-year survivor. My sister also with same; elected to do no radiation, but took tamoxifen. She is also long-term survivor.

Was diagnosed with malignant breast cancer, Feb 2018. I am 75 and a very small tumor was found by routine mammogram. The lumpectomy showed no surrounding tissue or lymph nodes involved. After analysis of the genetics of my tumor, the Oncotype DX showed that chemotherapy would not change the odds of a recurrence which were lower than 10%.

I did receive radiation therapy for 15 days but no chemo. I will see my medical oncologist next week to discuss possible pharmaceutical options going into the future. My treatment was exactly 4 months from discovery to the end of radiation. So grateful to skip chemo but it should be noted that different results from the Oncotype DX analysis might have shown a definite benefit from chemotherapy.

This makes me wonder how many other cancers do not need chemo, and how many victims have died from chemo complications, that did not really need it. It sickens me. I stopped donating to cancer causes years ago.

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