An analysis of the use of chemotherapy and hormonal therapy for early-stage breast cancer suggests an increase in the use of adjuvant therapy, particularly among node-negative women. These results were published in the Journal of Clinical Oncology.

Adjuvant therapy is additional treatment administered after initial surgery and radiation therapy. The goal of adjuvant therapy is to eliminate any cancer that remains after surgery or radiation therapy, thereby reducing the risk of cancer recurrence.

Despite undergoing surgery and radiation, some breast cancer patients already have small amounts of cancer that have spread outside the breast. These cancer cells are referred to as micrometastases and cannot be detected with any of the currently available tests.

The presence of micrometastases causes breast cancer recurrence following local treatment with surgery and/or radiation therapy. To reduce the risk of cancer recurrence, breast cancer patients may receive adjuvant therapy with chemotherapy, hormonal therapy, or biologic therapy.

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To evaluate trends in the use of adjuvant therapy for early-stage breast cancer, researchers analyzed information from a national cancer database. The study included a total of 9,481 women who were diagnosed with breast cancer beginning in 1987 through 1991, 1995, or 2000. The researchers assessed trends in the use of chemotherapy and hormonal therapy by nodal status (whether cancer had spread to lymph nodes) and estrogen receptor status (positive or negative).

  • Between 1995 and 2000, the use of chemotherapy plus tamoxifen increased from 8% to 21% among women with node-negative, estrogen receptor-positive breast cancer that was one centimeter or larger in size. Use among node-positive, estrogen receptor-positive patients increased from 30% to 57%.
  • Among women with node-negative, estrogen receptor-negative breast cancer, the use of chemotherapy alone increased from 48% to 59% between 1995 and 2000.
  • Use of anthracycline-based chemotherapy increased over time.
  • Chemotherapy was less commonly given to women over the age of 70 years.

The researchers conclude that trends in the use of chemotherapy and hormonal therapy suggest that physicians have responded to recommendations about breast cancer therapy. The majority of women with early-stage breast cancer were receiving adjuvant therapy, and there was an increase in the use of anthracycline-based chemotherapy regimens between 1995 and 2000.The lower use of chemotherapy in women over the age of 70 may be explained by the lack of definitive clinical trial results in this age group.

Reference: Harlan LC, Clegg LX, Abrams J et al. Community-Based Use of Chemotherapy and Hormonal Therapy for Early-Stage Breast Cancer. 1987-2000. Journal of Clinical Oncology. 2006;24:872-877.

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