According to a recent article published in the journal Cancer, the Proceedings of the Consensus Conference on Neoadjuvant Chemotherapy in Carcinoma of the Breast recommends that neoadjuvant chemotherapy is “the appropriate treatment choice” for patients with stages III breast cancer, and is “worthy of consideration” for patients with stages IIA and IIB breast cancer. It is important for patients who have been diagnosed with these stages of breast cancer to speak with their physician about their individual risks and benefits of neoadjuvant chemotherapy.

Approximately 250,000 women are diagnosed annually with breast cancer in the United States alone. Patients with early breast cancer often have their cancer removed and receive follow-up treatment with radiation, chemotherapy and/or hormonal therapy. However, patients with larger breast cancer that has not spread from the breast to distant sites in the body (locally advanced) may still undergo a mastectomy (complete removal of the breast) followed by additional therapy. Stages IIA, IIB and III breast cancer are often considered to be locally advanced. Stage II breast cancers are a primary cancer that either involves axillary (under the arm) lymph nodes and is less than 5cm (2 inches) in size, or is greater than 2 centimeters (3/4 inch) in size and does not involve any axillary lymph nodes. Stage III breast cancers typically have one of three scenarios: 1) a primary cancer that measures less than 5cm (2 inches) in size and causes axillary lymph nodes to be attached to each other or other structures 2) a primary cancer that is greater than 5cm (2 inches) in size and involves axillary lymph nodes or 3) a primary cancer that is attached to the chest wall or skin.

Neoadjuvant chemotherapy refers to therapy administered prior to the surgical removal of the cancer and has been studied extensively in several types of cancer, including breast cancer. Neoadjuvant chemotherapy may be used to shrink the cancer so that surgical removal of the cancer may be complete without a mastectomy. However, no clinical studies to date have demonstrated an improved survival with the use of neoadjuvant chemotherapy. Previous studies have clearly demonstrated that the use of neoadjuvant therapy reduces the rate of mastectomies performed, allowing more women to undergo breast-conserving therapy without compromising long-term outcomes. However, literature has never clearly defined the most appropriate uses for neoadjuvant therapy in the clinical setting for locally advanced breast cancer, and women often receive different therapeutic strategies depending on their treating physician.

The Consensus Conference Committee of Neoadjuvant Chemotherapy in Carcinoma of the Breast had recently published proceedings or guidelines regarding the optimal strategy for neoadjuvant chemotherapy in locally advanced breast cancer. The guidelines were published after an extensive review of clinical studies evaluating neoadjuvant chemotherapy in different stages of breast cancer. The panel came to the consensus that neoadjuvant chemotherapy is “the treatment of choice” for patients with stage III breast cancer and is “worthy of consideration” in patients with stage IIA and IIB breast cancer. Individual characteristics of the patient and cancer (such as the number axillary lymph nodes involved) come under consideration, however, when ultimately deciding upon the optimal treatment regimen for each patient.

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Patients who have been diagnosed with stages II or III breast cancer and are candidates for chemotherapy may wish to speak with their physician about their individual risks and benefits of treatment including neoadjuvant chemotherapy.

Reference: Schwartz GF, Hortobagyi GN and the Consensus Conference Committee. Proceedings of the Consensus Conference on Neoadjuvant Chemotherapy in Carcinoma of the Breast, April 26-28, 2003, Philadelphia, Pennsylvania. Cancer. 2004;100:2512-2532

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