SMOKINCHOICES (and other musings)

June 7, 2018

Breast Cancer, . . can I skip chemo?

Skipping Chemo OK for some, study finds 

The following is excerpted from the New York Times – – a rather big “Good News for Women with Breast Cancer” (my comment follows):

Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major international study that is expected to quickly change medical treatment.

“We can spare thousands and thousands of women from getting toxic treatment that really wouldn’t benefit them,” said Dr. Ingrid A. Mayer, from Vanderbilt University Medical Center, an author of the study. “This is very powerful. It really changes the standard of care.”

The study found that gene tests on tumor samples were able to identify women who could safely skip chemotherapy and take only a drug that blocks the hormone estrogen or stops the body from making it. The hormone-blocking drug tamoxifen and related medicines, called endocrine therapy, have become an essential part of treatment for most women because they lower the risks of recurrence, new breast tumors and death from the disease.

“I think this is a very significant advance,” said Dr. Larry Norton, of Memorial Sloan Kettering Cancer Center in New York. He is not an author of the study, but his hospital participated. “I’ll be able to look people in the eye and say, ‘We analyzed your tumor, you have a really good prognosis and you actually don’t need chemotherapy.’ That’s a nice thing to be able to say to somebody.”

The findings apply to about 60,000 women a year in the United States, according to Dr. Joseph A. Sparano of Montefiore Medical Center in New York, the leader of the study.    “The results indicate that now we can spare chemotherapy in about 70 percent of patients who would be potential candidates for it based on clinical features,” Dr. Sparano said.

This year, about 260,000 new cases of breast cancer are expected in women in the United States, and 41,000 deaths. Globally, the most recent figures are from 2012, when there were 1.7 million new cases and more than half-a-million deaths.

Chemotherapy can save lives, but has serious risks that make it important to avoid treatment if it is not needed. In addition to the hair loss and nausea that patients dread, chemo can cause heart and nerve damage, leave patients vulnerable to infection and increase the risk of leukemia later in life. TAILORx is part of a wider effort to fine-tune treatments and spare patients from harsh side effects whenever possible.

Endocrine therapy also has side effects, which can include hot flashes and other symptoms of menopause, weight gain and pain in joints and muscles. Tamoxifen can increase the risk of cancer of the uterus.

The gene test, called Oncotype DX Breast Cancer Assay, is the focus of the study. Other gene assays exist, but this one is the most widely used in the United States. It is performed on tumor samples after surgery, to help determine whether chemo would help. The test is generally done for early-stage disease, not more advanced tumors that clearly need chemo because they have spread to lymph nodes or beyond.

The test, available since 2004, gives scores from 0 to 100. It costs about $3,000, and insurance usually covers it. Previous research has shown that scores 10 and under do not call for chemotherapy, and scores over 25 do.

But most women who are eligible for the test have scores from 11 to 25, which are considered intermediate.

“This has been one of the large unanswered questions in breast cancer management in recent times, what to do with patients with intermediate scores,” Dr. Norton said. “What to do has been totally unknown.” He added, “A lot of patients in that range are getting chemo.”

Dr. Sparano said many patients have been receiving chemo because in 2000 the National Cancer Institute recommended it for most women, even those whose disease had not spread to lymph nodes, based on studies showing it could prevent the cancer from recurring elsewhere in the body and becoming incurable.

“Recurrences were being prevented, and lives prolonged,” Dr. Sparano said. “But we were probably overtreating a lot of these women. For every 100 women we were treating, we were probably preventing about 4 distant recurrences.”

Dr. Mayer said, “We couldn’t figure out who we really needed to treat.”

The availability of the gene test in 2004 helped researchers sort out women with very high or very low risk.

“But we really didn’t know what to do with women in the middle,” Dr. Mayer said. “Some seemed to benefit and some didn’t. We were back to square zero, safe rather than sorry, giving chemo to a lot who didn’t need it.”

Data began to emerge suggesting that women in the middle were not being helped by chemo, and many doctors began recommending it less often. But a definitive study was needed, which is how TAILORx came about.

The study began in 2006 and eventually included 10,253 women ages 18 to 75. Of the 9,719 patients with complete follow-up information, 70 percent had scores of 11 to 25 on the gene test. They had surgery and radiation, and then were assigned at random to receive either endocrine therapy alone, or endocrine therapy plus chemo. The median follow-up was more than seven years.

Over time, the two groups fared equally well. Chemo had no advantage. After nine years, 93.9 percent were still alive in the endocrine-only group, versus 93.8 percent in those who also got chemo. In the endocrine group, 83.3 percent were free of invasive disease, compared with 84.3 percent who got both treatments. There were no significant differences.

But the researchers wrote that the chemotherapy benefit varied with the combination of recurrence score and age, “with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25.”

There is no question regarding the benefit of this advancement, freeing so many thousands of women who otherwise would have to go thru  Chemo in order to assure their safety and forward-going life. 

What remains a mystery is the cause,  and “why” – – some idea why this happens.  When we know what caused something, there is a higher chance of ably correcting it.  The medical community has ascertained numerical percentages of how many new cases there will be and can estimate the probable death-rate thereof.  But the crap-shoot remains  – -who and why?   Am I an expert on this?  NO.   Do I know/understand even half as much as the doctors do?  No, indeed.    But do I really need all that?. . . isn’t it possible I don’t need to,   if I understand where its coming from, how it happens and what can be done to correct it, if it comes my way?  That is an advantage of forward thinking,  careful choices regarding how and what I eat, think and live. . . so that I can have security and peace of mind.  And not worry.  This then is post #1 following up the 6-6-18 post titled “The Relevance of Clark Theory.   

With Dr Clark’s book,  “The Cure for All Disease”  one is theoretically taken by the hand and led from page to page with concepts and new realities before getting to page one.  She starts off with discussing the Syncrometer, a testing device of her own design which is both accurate and versatile.  This is used in detecting and measuring  for pollutants and parasites, and location sites of diseases within the body.  .  This is noteworthy because, first off – her generosity, plus her belief in us to do this research for ourselves.  And to do it – we need the tools.  This one is superior to what can be found on the open market. Dr Clark gives full instructions on building your own so that we can be independently successful in taking care of ourselves with the technology she provides in her books.  IMO, this is fabulous…but they do have this equipment ready to go for those who don’t wish to DIY.     

At 35, I went through a number of years worried over a lump in the upper quadrant of my left breast.  After examining, my doctor was satisfied that there was nothing  wrong and asked me not to worry over it.  Had a very close personal friend who was experiencing the same thing concurrently.  We discussed and commiserated  for some time, but in due course, Donna  couldn’t put it off anymore and pressed her physician into more conclusive testing. . . she knew there was something wrong..   .   she just felt it  (as I did).  Biopsy, .  .  .  hospital,  .  .  it was cancer.  Donna died in less than a year.  We both had so much in common.. it was very hard to get thru.  Everyone was shaken and shocked.  My lump continued threatening me for  along time – through my 50’s.  Eventually I didn’t notice it anymore.   However, women DO go through a lot of worry and low-grade stress.  What I now know,  it doesn’t have to be that way.    When something goes wrong  anywhere in the body, one can test for pollutants and parasites and also any or all parts of the body – if there is a problem and if so, what it is.  To correct the problem, use  the Zapper and recipes in the book or both as the case may be.         

If one can open to the simplicity of the Clark theory, learn some new ways of thinking and doing;  give up foods containing the harmful solvents and other pollutants,  use the zapper for pain and killing the parasites. . .any problem can subside in hours, days or weeks and maybe longer depending on the degree of the problem.  Kinda works the same for any big scary-sounding disease, so forget the name and remember what it really is;  either stop allowing the  pollutant into your body,  or zap the parasites — its one or the other or both.    Ya feel better right away     Jan

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