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Chemotherapy and/or Tamoxifen Recommended Even for Women with Small Breast Cancers (dateline January 22, 2001)

Researchers recommend that women with small breast tumors should also consider undergoing chemotherapy or drug treatment with tamoxifen in addition to breast cancer surgery to help prevent a recurrence of cancer. The recommendation is based on an analysis of patients from five clinical trials which shows an increase in disease-free survival among women with small tumors (one centimeter or less) and no cancerous lymph nodes who are treated with chemotherapy or tamoxifen versus those who just have surgery. In November 2000, a National Institutes of Health (NIH) panel of experts of national and international experts made similar recommendations.

The new data were collected from clinical trials conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP) and published in the Journal of the National Cancer Institute. The data show that among the 235 women with estrogen receptor negative breast cancers, adding chemotherapy in addition to breast cancer surgery increased eight-year disease-free survival from 81% to 90%. Among the 1024 women with estrogen receptor positive breast cancers, adding tamoxifen to surgery increased eight-year disease-free survival from 86% to 93% and to 95% among women who were treated with both tamoxifen and chemotherapy in addition to surgery.

Physicians also made treatment recommendations at the three-day NIH Consensus Development Conference on Adjuvant Therapy for Breast Cancer, which was held from November 1 to November 3, 2000 at the NIH in Bethesda, Maryland. At the NIH conference, experts said that chemotherapy should be recommended to most pre-menopausal and post-menopausal women with localized breast cancer, regardless of whether their cancer has spread to the lymph nodes or has estrogen receptors. The panel also recommended that hormonal therapy (most commonly with tamoxifen) be offered to women whose breast tumors contain estrogen receptors, regardless of age, menopausal status, tumor size, or whether the cancer had spread to the axillary (underarm) lymph nodes.

Physicians typically examine hormone receptors in breast cancer cells at the time of biopsy or breast surgery to determine whether estrogen receptors are present. Estrogen receptor positive breast cancers depend on estrogen for survival and tend to respond to therapies such as tamoxifen that prohibit estrogen from reaching the receptors. In many cases, physicians may also remove some or all of the axillary (armpit) lymph nodes to determine whether breast cancer has begun to spread.

While Dr. Fisher and his colleagues recommend that women consider adjuvant (additional) therapy, even if their tumors are less than one centimeter, an editorial by Dr. Marc Lippman notes that the data used to make the recommendations was collected during the late 1980s and early 1990s. With the increased use of screening mammography in recent years, physicians are detecting smaller cancers. When breast cancer is found at a very early stage and treated with surgery, the chances for survival are approximately 95%. Therefore, Dr. Lippman questioned whether the added benefit of chemotherapy would outweigh the potential side effects of the treatment.

Common Side Effects



Hair loss
Hot flashes
Vaginal irritation
Irregular menstrual cycles

While it is important not to delay action, a patient should have a sufficient amount of time to discuss her treatment options with her physicians and family and make an informed decision on how to best proceed with treating the disease. A period of a few weeks or even a month is not unusual in preparing for definitive surgery (such as lumpectomy or mastectomy) and planning subsequent therapy (such as chemotherapy, radiation, or drug therapy).

Additional Resources and References