you didn't read the entire article... do i need to keep pulling mainstream articles for you, read this....

Doctors Rethink the Wisdom Of Chemo for Breast-Cancer
By Susan M. Love MD
Reprinted from The Wall Street Journal
October 9, 2002

Most women with Breast Cancer endure the agony of chemotherapy to improve their chance of survival. But the truth is, most of them would do just as well without it.

A growing realization that women are being vastly over-treated with toxic and dangerous drugs is prompting a widespread rethinking among doctors about the use of chemotherapy. For years chemo has been the standard treatment for anyone with Breast Cancer -- and it still is in most cases. But now that women are identifying the disease sooner and living longer, physicians are starting to notice more long-term repercussions from chemotherapy. At the same time, recent studies show that in certain patients, hormonal drugs such as tamoxifen work better.

Already a small number of women are choosing to say "no" to chemotherapy, even against a physician's advice. When Sherry Goldman, 56, was diagnosed with early-stage Breast Cancer last year, she opted to be treated with a lumpectomy and radiation. A doctor advised her also to take chemotherapy. Without it, she was told, she had about a 90% chance of staying cancer-free. With chemo, her chances were 93%.

"It wasn't worth it to me," says Ms. Goldman, a nurse practitioner at the UCLA cancer center. "I wasn't willing to take the risk of possibly not being myself again."

While most side effects of chemotherapy -- such as nausea and hair loss -- are temporary, others are more serious. Chemotherapy can trigger early menopause. Some women develop memory loss and fuzzy thinking often called "chemo brain." Most worrisome, a fraction of women will develop a second cancer such as leukemia, or serious heart problems as a result of the treatment.

Nevertheless, chemotherapy clearly saves lives. For most women with cancer that has spread to the lymph nodes, the benefits almost always far outweigh even the most serious risks. But for women with relatively small tumors whose cancer hasn't spread to the nodes, the decision about chemotherapy is far more difficult.

If you take 10 such women and treat them with surgery and radiation, seven will be fine after a decade and three will have died, research shows. If you add chemotherapy, one additional woman would be saved. "The problem is you don't know whether you're in the three or the seven," says Susan Love, author of "Dr. Susan Love's Breast Book." "It's acknowledged that we're over-treating people, but the problem is we don't know who's who."

Doctors are searching for "markers" to help them better identify the 20% to 30% of women who will relapse even though their cancer is caught very early. Too many copies of a gene called Her-2, for instance, may signal a more aggressive cancer, which may be better treated with certain types of chemo and the drug Herceptin.

As research into other markers continues, there are some questions a woman can ask now to help decide whether to undergo chemo.

Are you pre- or post-menopausal? Studies show chemotherapy is far more effective in younger women, lowering death rates by 27% in women under 50. In patients over 50, death rates are reduced by only 11%.

What are the alternatives? Because 80% of breast cancers are fueled by estrogen, hormonal drugs that suppress estrogen, such as tamoxifen or Arimidex, may work just as well as chemotherapy in certain women.

Tamoxifen can have serious side effects, such as endometrial cancer, although doctors say that disease is far easier to cure than breast cancer. Arimidex was approved by the FDA last month to treat early breast cancer and may do a better job of preventing relapse with fewer side effects. However, no long-term studies are available. Another option is to suppress the body's estrogen production, either by surgical removal of the ovaries or by blocking them with radiation or medication.

Is your tumor sensitive to estrogen? Women whose cancers aren't stimulated by estrogen (estrogen-receptor-negative tumor) may have the most to gain from chemotherapy. A new study published in the Journal of the National Cancer Institute questions the need for chemotherapy among post-menopausal women with estrogen-receptor-positive tumors. For them, tamoxifen by itself worked as well. But the study makes a strong argument for chemo in patients with ER-negative tumors. For them, chemo improved survival by 15%, says Richard Gelber, a Harvard Medical School biostatistician who led the study.

What is my absolute benefit? Chemotherapy reduces a woman's risk of recurrent cancer by about 30%, but that isn't as big as it sounds. It means that if her risk of getting cancer again is 10%, then, on average, chemotherapy will lower her risk by a third, to about 7%.

For a more individual assessment, some doctors use computer tools, such as Adjuvant!, developed by oncologist Peter M. Ravdin, clinical associate professor at University of Texas Health Science Center at San Antonio. It shows that a 65-year-old woman with a 1.8-cm ER-positive tumor that hasn't spread has a 9% chance of dying of breast cancer in 10 years. Chemotherapy lowers her risk only to 8.5%. Tamoxifen would lower it to 7%. Her chance of dying of something else altogether is 12%.

Many women will still opt for chemo no matter what. "It's amazing how small a benefit patients actually need," says Andrew D. Seidman, associate attending physician at Memorial Sloan Kettering Cancer Center. "But after hearing all the appropriate discussion, intelligent people can make the decision not to get chemotherapy."


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