Chemotherapy after Lumpectomy Decreases Recurrences in Women with Breast Cancer

Chemotherapy after Lumpectomy Decreases Recurrences in Young Women with Breast Cancer without Spread to the Lymph Nodes

The treatment for young women who develop breast cancer often consists of surgery followed by chemotherapy for those with cancer that has spread to the lymph nodes under the arm (advanced localized breast cancer) and surgery with or without radiation therapy for women with smaller cancers that have not spread to the lymph nodes under the arm (localized breast cancer). Now, researchers in the Netherlands and Belgium say that young women who have surgery (followed by radiation therapy) for localized breast cancer should also receive chemotherapy after the surgery.

Treatment options for persons withadvanced localized breast cancer usually involves surgery to remove the cancer and surrounding tissue (lumpectomy) or to remove the breast (mastectomy). To kill any cancer cells that may remain and to prevent a recurrence (return) of the cancer, treatments such as chemotherapy, radiation therapy, and/or hormone therapy are usually administered after surgery. However, for persons with localized breast cancer that is small in size or that has not spread to the lymph nodes, the likelihood of recurrence is thought to be low, and chemotherapy is not routinely given by physicians. Researchers from the Netherlands and Belgium recently evaluated young women who had a lumpectomy for localized breast cancer, followed by 1 course of chemotherapy.

All of the young women in this study underwent a lumpectomy for localized breast cancer, followed by radiation therapy. Thirty-six hours after the surgery, half of the women were also treated with 1 course of chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide. The results showed that after 5 years, the recurrence rates were 12% in the women who did not receive chemotherapy, compared with only 5% in those who did receive chemotherapy. Similarly, after 8 years, the recurrence rates were 20% in the women who did not receive chemotherapy, compared with only 10% in those who did receive chemotherapy. The overall survival rates after 8 years were 91% for the women who received the chemotherapy, and 88% for those who received only surgery and radiation therapy.

These findings add to a number of previous reports that indicate that young women who have localized breast cancer without lymph node involvement, may benefit from chemotherapy after surgery. Future studies to determine the most effective number of chemotherapy cycles are needed. Young women with localized breast cancer may wish to talk with their doctor about the risks and benefits of receiving chemotherapy after surgery. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (Journal of Clinical Oncology, Vol 18, No 5, pp 1075-1088, 2000)

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