Today the vast majority of women diagnosed with breast cancer receive surgery of some kind, radiation and chemotherapy, regardless of the prognosis or stage of their disease.
“Will my cancer spread?” is a question every woman grapples with. That’s why many women and their doctors choose to throw every treatment option available at their cancer. The question is whether this aggressive approach is, in many cases, overkill.
Difficult as it may be for doctors and patients to understand and accept, in some cases, women might be better off living with cancer–as long as it is Stage 0 and under close supervision by physicians–than treating it. Duke University is about to launch a study measuring the outcome of surgery with or without radiation against that of active surveillance with no immediate treatment; women with ductal carcinoma in situ will be randomly assigned to one study arm or the other. The trial, called COMET, will begin enrolling women this year. Currently, most women are still making the choice to do what is aggressive, but there are an increasing number of patients who want an alternative.
For those with invasive cancers, there may be occasions where less is more. Increasingly, sophisticated genetic testing of tumors can identify genetic changes that might signal cancers that are more likely to recur but also predict how effective chemotherapy and hormone-based drugs might be against the tumors. These next-generation tests can help doctors choose a more personalized treatment course, sparing a patient unnecessary chemotherapy or extensive surgery.
This new approach challenges decades of messages from cancer experts that stressed that living with even a little cancer was too dangerous. As our abilities to find even small lesions have improved, our definitions of cancer have moved from a 19th century definition to a 21st century definition says the American Cancer Society. Today the understanding of the biological behavior of some of these smaller lesions is better and researchers think that the biological behavior may not be the same as the larger lesions found in the past.
Dr Hwang from Duke University ( Accompanying picture) is optimistic that more research will support that view. “It’s a very exciting time to be a breast-cancer researcher,” she says, “and on the flip side, there’s never been a better time to be a breast-cancer patient in terms of the good outcomes they can expect from treatment.”