Chemotherapy in breast cancer does not always make sense

New test procedure can avoid unnecessary chemotherapy for breast cancer

05/31/2012

Breast cancer is the most common form of cancer in women and is still treated by default with a combination of surgery, radiation and chemotherapy. However, according to current scientific findings, chemotherapy harms many patients more than they actually use, he says „North German Broadcasting“ (NDR).

Chemotherapy is not always the drug of choice
Given the side effects of chemotherapy, use in many breast cancer patients is rather counterproductive and, if in doubt, worsens the state of health. the „NDR“ the improved early detection has led to the breast carcinoma (breast cancer) „often discovered today at a very early stage“. However, according to current research, chemotherapy is only medically useful if the tumor has already spread to the lymph nodes. Nevertheless, most patients receive a form of preventive chemotherapy, even if the cancerous tumor has been detected at an early stage and surgically removed.

Breast cancer is the most common tumor in women
According to the World Health Organization (WHO), breast cancer is the leading cause of death in women between the ages of thirty and sixty in the western industrial nations. The number of diagnoses has increased steadily in recent years, but the mortality rate has declined. Today, more than 70,000 new cases are registered every year in Germany, and nearly 18,000 patients are struggling with the consequences of their illness. Every eighth woman in Germany falls ill with breast cancer once in her life. In recent decades, the early detection has improved significantly, not least because of the comprehensive mammography screening and the improved diagnostic procedures, with the result that the tumors are often discovered today at a very early stage. This raises the question for cancer experts worldwide, whether the previous treatment with surgical intervention, followed by several weeks of radiation and chemotherapy, still meets the requirements. Although two-thirds of the patients can be cured based on this treatment, chemotherapy may not have a significant impact on the cure for early breast cancer.

Chemotherapy only makes sense if cancer has spread
Recent studies conclude that the risk-benefit assessment justifies chemotherapy only in breast cancer, if it has also spread to the lymph nodes. Contrary to these findings, however, in practice, most patients are advised to take preventive chemotherapy even in the case of early breast cancer. The difficulty lies in the assessment of the risk of metastasis formation, so that often chemotherapy is used. To remedy this malady, researchers worldwide are working on new test methods that can detect the risk of lymph node involvement. Again „NDR“ reported, the scientists use the „Protein uPA (urokinase-type plasminogen activator) and its antagonist PAI-1 (plasminogen activator inhibitor 1)“ to determine the risk of metastasis. The proteins can be examined by means of a tissue sample, which is taken during the surgical removal of the tumor, according to the statement of the experts in an interview with the „NDR“. A low level of uPA / PAI-1 in tumor tissue suggests that there is a low risk of relapse for the patients.

The affected breast cancer patients with low risk of relapse could „avoiding mentally and physically burdened concomitant chemotherapy without increasing the risk of recurrent disease“, so the statement in the „NDR“-Report. However, the tissue sample must already be taken during the operation and in retrospect, this possibility of risk assessment is no longer applicable. Although the test is not yet under the benefit catalog of the statutory health insurance, but some insurance already take the cost of around 300, - €.

Onkotype DX test procedure to determine the risk of cancer recurrence
Another approach to identifying cancer recurrence risk is being pursued in the ADAPT study. In the future, this should help to optimize the therapies of breast cancer patients and avoid unnecessary chemotherapies. For this purpose, around 4000 subjects between the ages of 18 and 75 are being examined throughout Germany with a hormone receptor-positive breast cancer without lymph node involvement. The individual risk of breast cancer recurrence is determined by analyzing 21 genes from one tissue sample. Thereafter, the samples are shipped to a US lab. If a low risk is determined, it may be possible to do without chemotherapy, as Prof. Dr. med. Tjoung-Won Park-Simon, Deputy Director of the Department of Obstetrics and Gynecology Division Head of Gynecological Oncology to the NDR magazine reports. The procedure is offered not only in Hamburg's Jerusalem Hospital, but also in other clinics in Germany. The test called Onkotype DX, however, is not covered by the statutory health insurance, but must be paid depending on the annual income of the patients themselves. The test procedure costs between 150 and 300 euros. (Fp)

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