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New breast cancer test may mean some women don’t need chemotherapy

The NHS is to begin using a test that should mean that some women with certain types of breast cancer don’t need to have chemotherapy after surgery.
By Grant Stewart

BMJ Group News

What do we know already?

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Breast cancer is the most commonly diagnosed cancer in women in the UK. Nearly 50,000 women, and a few hundred men, are diagnosed with the disease in the UK each year. Most women with breast cancer will have surgery to remove either the whole affected breast or just the tumour (breast-conserving surgery).

Most women have medication called chemotherapy for several months after having surgery, to try to stop the cancer from coming back. Doctors recommend chemotherapy especially when they think cancer has a moderate or high chance of coming back, usually because the cancer has spread or grown quickly. Chemotherapy can be given as a drip directly into the vein, or as tablets.

Chemotherapy doesn’t work for everyone who has breast cancer, but it stops breast cancer returning in many women. However, most women who have surgery for breast cancer don’t actually need chemotherapy. Their cancer would not come back even if they didn’t have the drug treatment. But until recently, it wasn’t possible to tell which women need the drugs and which don’t. So, doctors recommend chemotherapy for all women whose cancer might come back.

This is a problem because chemotherapy can cause very unpleasant side effects, including hair loss, vomiting, feeling very sick, extreme tiredness, and weight gain. So a test that could help some women avoid the need for chemotherapy would save a lot of needless suffering.

What does the report say?

A report from the National Institute for Health and Care Excellence (NICE) says a new test called Oncotype DX can be used by the NHS for some women with breast cancer.

In women with certain types of breast cancer, the new test can help predict what will happen after they have had surgery, and in particular how likely their cancer is to return. The Oncotype DX test is useful for women who have the following types of breast cancer:

  • Oestrogen receptor positive (ER+) breast cancer
  • Lymph node negative (LN−) breast cancer
  • Human epidermal growth factor receptor 2 negative (HER2−) early breast cancer.

The test is not recommended for everyone with those types of cancer, but only for those women who are thought to have more than a small risk of their cancer returning. In all, the NICE report authors think that the test could help about one fifth of women with breast cancer (about 10,000 women each year) find out if they really need to have chemotherapy.

What does this mean for me?

Being diagnosed with breast cancer is bound to be upsetting and worrying. Having any kind of surgery can be stressful. But for a woman facing surgery that might mean the removal of a breast, the emotional impact can be huge. Add to this months of very unpleasant side effects from drug treatment that might not even be necessary, and you could be forgiven for thinking that the cure really is, as the saying goes, worse than the disease.

This test isn’t a treatment for cancer, and it won’t help anyone live longer. But, if it could remove the need for some of the most unpleasant cancer treatments for some women with breast cancer, it would be very welcome news indeed.

Published on September 27, 2013

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