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Determining Which Breast Cancer Patients Can Skip Chemotherapy

Determining Which Breast Cancer Patients Can Skip Chemotherapy

CHICAGO—The overwhelming majority of women with invasive breast
cancer who are node-negative, both those with positive and negative estrogen
receptors, routinely receive chemotherapy today. "But it’s worthwhile to
step back and ask whether we can define groups of women who should not
routinely receive chemotherapy," Monica Morrow, MD, said at the Lynn Sage
Breast Cancer Conference.

Dr. Morrow is professor of surgery and director of the Lynn Sage
Comprehensive Breast Center, Northwestern University Medical School.

"Potentially, there are three such groups," she noted. The first
includes patients with an extremely favorable prognosis who are unlikely to
experience any meaningful prolongation of survival from a treatment that could
be both toxic and costly.

She would also exclude patients in whom clear evidence of benefit from
chemotherapy is lacking and those in whom toxicity would outweigh benefits.

Extremely Favorable Prognosis

The "extremely favorable prognosis" group includes subsets of
node-negative breast cancer patients with tumors no larger than 1 cm. Survival
rates (at 5 to 10 years, depending on the study) in these women exceed 90%,
according to a number of reliable databases, she said.

In the Breast Cancer Diagnosis and Demonstration Project (BCDDP), stage I
cancers had an 8-year survival of 90%; those less than 1 cm were associated
with a 95% survival rate. Surveillance, Epidemiology, and End Results (SEER)
data from the same period are similar. In 5,479 women, stage I cancer carried a
92% 5-year survival rate.

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