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.
