When people think cancer they inevitably think chemotherapy. For some patients the link is so strong that they request chemotherapy even if their doctor doesn't recommend it. But The New York Times claims more and more doctors are questioning the role of chemotherapy in treating breast cancer. Gina Kolata reports:
Today, national guidelines call for giving chemotherapy to almost all of the nearly 200,000 women a year whose illness is diagnosed as breast cancer. In the new approach, chemotherapy would be mostly for the 30 percent of women whose breast cancer is not fueled by estrogen.
So far the data are tantalizing, but the evidence is very new and still in flux. And even if some women with hormone-dependent tumors can skip chemotherapy, no one can yet say for sure which women they might be. Some doctors have already cut back on chemotherapy, but the advice a woman gets often depends on which doctor she sees.
It hasn't yet inspired wholesale changes in treatment.
"It's a slightly uncomfortable time," said Dr. Eric P. Winer, who directs the breast oncology center at the Dana-Farber Cancer Institute in Boston. "Some of us feel like we have enough information to start backing off on chemotherapy in selected patients, and others are less convinced."
Among the less convinced is Dr. John H. Glick, director of the Abramson Cancer Center of the University of Pennsylvania. Dr. Glick tells his patients about the new data but does not suggest they skip chemotherapy. After all, he notes, the national guidelines were based on results from large randomized clinical trials. And the recent data indicating that some women can skip chemotherapy are based on an after-the-fact analysis of selected clinical trials.
"We're in an era where evidence-based medicine should govern practice," Dr. Glick said.
For years Dr. Fuhrman has insisted chemotherapy isn't the sun, the moon, and the stars in breast cancer treatment. He explains in a previous post entitled Diet, Chemotherapy, and the Truth: How to Win the War on Cancer:
Chemotherapy has contributed to the progress made against cancer deaths from fast-growing cancers, such as leukemia, lymphoma, testicular cancer, and childhood cancers such as osteogenic sarcoma. But for the major cancers affecting most adult Americans, chemotherapy adds less than one year of disease-free life to those treated…
Does Chemotherapy Work?
Let's see how effective chemotherapy actually is with a few common cancers.
- A meta-analysis of chemotherapy for postmenopausal, estrogen receptor-positive women (the largest group of women with breast cancer) pooled the six largest studies to get the most accurate data on survival and complications. Here is what researchers concluded about the group treated with standard chemotherapy: "No significant survival benefit was observed."1
- In non-small cell lung cancer (the most common type), the 5- year survival is only about 10 percent. In stage 4, when the cancer has spread to distant sites, the 5-year survival is only 1.6 percent. After looking at multiple studies, it appears that treatment generally results in a very slight improved survival rate at 1 year, but this advantage disappeared at 30 months of follow-up.2
- Even in small cell lung cancer where chemotherapy has proven effectiveness in life extension, the benefit adds only a few months of life, not years. And during this time the patient can experience serious—even life threatening—side effects from the treatment.
No doubt this uncertainty among doctors further complicates an already difficult situation. Dr. Fuhrman provides some advice for those confronting cancer:
Every patient has to make her own decision. But if I were a woman with postmenopausal breast cancer, I would opt for surgery, without radiation and without chemotherapy, and would then pursue an aggressive nutritional protocol. I also would include antiestrogens if the tumor histology showed it to be estrogen receptor-positive.
1. Hartman AR, Fleming GF, Dillon JJ. Metaanalysis of adjuvant cyclophosphamide/methotrexate/ 5-fluorouracil chemotherapy in postmenopausal women with estrogen receptor-positive, node-positive breast cancer. Clin Breast Cancer 2001;2(2):138-143.
2. Blackhall FH, Bhosle J, Thatcher N. Chemotherapy for advanced non-small cell lung cancer patients with performance status 2. Curr Opin Oncol 2005 Mar;17(2):135-9.