SAN ANTONIO — Tens of thousands of women each year might be able to skip at least some of the grueling treatments for breast cancer — which can include surgery, heavy chemo and radiation — without greatly harming their odds of survival, new research suggests.
The research is aimed at curbing overtreatment. Treatments help many women beat the disease, but giving too many or ones that aren't really needed causes unnecessary expense, trauma and lifelong side effects.
Several studies presented Wednesday at the San Antonio Breast Cancer Symposium, an international conference on the disease, identify groups of patients who might be able to safely forgo certain treatments.
Breast cancer is already widely spread in 5 to 20 percent of newly diagnosed patients, and at that point is usually incurable. The main treatment is chemotherapy or hormone treatments that attack cancer throughout the body. Sometimes doctors also remove the breast tumor in hope of prolonging survival, but this has not been put to a hard test.
Dr. Rajendra Badwe, director of the Tata Memorial Hospital in Mumbai, India, led a study of 350 women with widely spread cancers that had shrunk after initial chemotherapy. Half were given surgery to remove the breast or the lump plus any cancerous lymph nodes. The rest did not have surgery.
After about two years, 40 percent of both groups were alive.
Most breast cancers are found at an early stage, and many women are treated with surgery followed by hormones or chemotherapy, plus radiation. But cancer medicines have gotten so good at lowering the risk of a recurrence that doctors wonder whether the radiation is still needed.
Dr. Ian Kunkler of the University of Edinburgh in Scotland led a study of 1,326 patients 65 or older with early-stage cancers whose growth was driven by hormones. Half were given radiation and half skipped it.
After five years, roughly 96 percent of both groups were alive, and most deaths were not from breast cancer.
Doctors are unsure how to treat women with small tumors involving the gene that the drug Herceptin targets. Those tumors are low risk because they're still confined to the breast, but high risk because the gene is thought to make them more aggressive. Some women get heavy-duty chemo.
Dr. Eric Winer of the Dana-Farber Cancer Institute in Boston led a study of 406 women given "light chemo" — paclitaxel plus Herceptin for 12 weeks, followed by nine months of Herceptin alone. More than three years later, only four had cancer recur in the same breast, and two had recurrences in other places.