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Method Provides Pre-Surgery Chemotherapy To Breast Cancer Patients

Armen Hareyan's picture

Pre-Surgery Chemotherapy To Breast Cancer Patients

Although recent studies have shown that treating a breast cancerpatient with chemotherapy before surgery does not harm the woman'shealth, the method has not yet been proven to increase her chance ofsurvival, the AP/Washington Postreports. Most breast cancer patients who need chemotherapy receive itafter surgery, but more specialized cancer centers are advocatingchemotherapy for patients with earlier-stage cancer, and some clinicaltrials are testing the efficacy of the method, the AP/Post reports.

A panel of experts convened last spring by the National Cancer Instituteagreed that the method is a good option if chemotherapy can shrink anadvanced tumor to avoid removing a woman's breast or allow for a"markedly smaller" lumpectomy, according to the AP/Post.The panel urged more study into the efficacy of the procedure forearlier-stage breast cancer. Proponents of using pre-surgerychemotherapy for earlier-stage patients say it allows doctors to switchdrugs if the tumor does not respond to treatment immediately, the AP/Post reports. According to the AP/Post, there is "no way" to measure the efficacy of chemotherapy after surgery.

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According to the AP/Post,use of the methods often leads to "tough questions," including how totreat women who have some tumor left after chemotherapy; what to do ifphysicians switched pre-surgery chemotherapy several times; and howphysicians can tell if the tumor is shrinking. The "biggestcontroversy" over the method might be how to test and remove lymphnodes in women receiving pre-surgery chemotherapy, the AP/Post reports.

The"conundrum" of whether a woman is offered pre-surgery chemotherapy, andhow it is offered, "depends more on what doctor she chooses than onfirm guidelines," the AP/Post reports. Minetta Liu of Georgetown University Hospital-- a proponent of the method who estimates that up to 10% of herpatients who need chemotherapy choose it pre-surgery -- said, "I'm afan of letting patients know what their choices are," adding, "You'renot asking them to do something that's going to have a negative impacton their survival. It just may not help."

Clifford Hudis of Memorial Sloan-Kettering Cancer Centersaid more research is needed before the trend becomes routine. "Itshould not be used ... just because it exists," Hudis said. With breastcancer deaths dropping since 1990, "the notion that we should move to adifferent strategy should be challenged," he said, adding, "We haveuncharted territory."

Specialists are advising that anyoneconsidering pre-surgery chemotherapy get advanced testing, including a"big enough" biopsy, to ensure the patient is a good candidate for thetreatment, according to the AP/Post (Neergaard, AP/Washington Post, 7/23).

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Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserDaily Women's Health Policy Report, search thearchives, and sign up for email delivery at kaisernetwork.org/email. The Kaiser Daily Women's Health Policy Report is published forkaisernetwork.org,a free service of The Henry J. Kaiser Family Foundation.