According to a recent article published in the New England Journal of Medicine, small amounts of cancer cells present in the bone marrow of patients diagnosed with early breast cancer is associated with a significantly poorer survival within the first 5 years of diagnosis. Patients diagnosed with early breast cancer may wish to speak with their physician about undergoing a bone marrow biopsy and proceeding with treatment options according to biopsy results.
Breast cancer is diagnosed in approximately 250,000 women annually in the United States alone. Early breast cancer refers to cancer that may be present in a few axillary (under the arm) lymph nodes, but is not detected elsewhere outside of the breast. Although cure rates for patients with early breast cancer are high following standard therapy, a significant portion of these patients ultimately experience a cancer recurrence and succumb to the disease. Researchers have been evaluating possible disease or patient characteristics that impact survival or are associated with recurrence. Understanding these characteristics may allow patients at a higher risk to be treated more aggressively.
The bone marrow is the spongy material in the middle of large bones. In the bone marrow, immature cells are formed and released into the blood stream. In cancers affecting the blood or lymph system (such as leukemias or lymphomas) bone marrow biopsies are routinely performed to initially determine the extent of disease. Results from studies have also indicated that the presence of cancer cells among patients with solid tumors (not blood or lymph cancers) may also help predict a patient’s prognosis following standard therapy. A bone marrow biopsy or aspirate includes the removal of a sample of cells, typically from a bone in the pelvis. The sample is sent to a laboratory where a pathologist determines whether cancer cells are present.
Researchers from Europe recently analyzed pooled data from nine studies that were conducted to evaluate the prognostic value of bone marrow biopsies in women with early breast cancer. The data included over 4,700 patients with stages I, II, or III breast cancer. Follow-up was approximately 10 years. The presence of cancer cells in the bone marrow (micrometastasis in the bone marrow) was detected in approximately 31% of patients. Within the first 5 years of diagnosis, patients with micrometastasis to the bone marrow had significantly worse outcomes, including survival, compared to those with no micrometastasis to the bone marrow. Women with micrometastasis had a 93% increased risk of dying from breast cancer compared to women without micrometastasis. Furthermore, the risk of a recurrence, either near the site of the original cancer or at a distant site in the body, was approximately doubled in the group of patients with the presence of micrometastasis.
The researchers concluded that the presence of cancer cells in the bone marrow of patients with early breast cancer is strongly associated with poorer survival within the first 5 years of diagnosis. The researchers state the results from bone marrow biopsies should be included in future clinical trials when evaluating early breast cancer. Patients with early breast cancer, even stage I breast cancer, may wish to consult their physician about individual risks and benefits of a bone marrow biopsy or the participation in a clinical trial evaluating different treatment options stratified according to bone marrow biopsy results. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.
Reference: Braun S, Vogl F, Naume B, et al. A Pooled Analysis of Bone Marrow Micrometastasis in Breast Cancer. New England Journal of Medicine. 2005; 353:793-802.
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