A recent study published in Lancet medical journal has shaken up the breast cancer field. Traditionally, in order to prevent recurrences and extend longevity, we have treated early breast cancer patients who have hormone sensitive tumors with 5 years of the hormone blocker Tamoxifen. However, a recent study shows that 10 years of treatment results in improved rates of living longer without breast cancer.
The study involved 6,846 women with hormone sensitive breast cancer who had completed 5 years of Tamoxifen therapy. They were randomly chosen to either stop taking Tamoxifen or to continue with an additional 5 years, for a total of 10 years of Tamoxifen. The results showed that those women in the 10 year Tamoxifen group had less breast cancer recurrences and less breast cancer deaths. By year 15 breast cancer deaths had improved from 15% to 12.2% by the additional Tamoxifen treatment. The risks of taking more Tamoxifen included increased rates of uterine cancer (3.1% versus 1.6%) and pulmonary embolism [blood clot to the lung]. Overall though the amount of women dying from any causes were significantly smaller in the 10 year Tamoxifen group (639 versus 722).
Since this study has been presented, there has been much discussion about how to apply these results. Here are some thoughts:
Is the benefit of 3% (15% t0 12.2%) worth the additional 5 years of medicine. Our thoughts are that it depends upon how a woman tolerated Tamoxifen. If she barely noticed taking the medicine, then yes it makes sense. If she had side effects then 5 years would be fine.
What do we do with women who have DCIS or those who are taking an aromatase inhibitor? The real answer is that we don’t know.
Most people are leaning towards increasing the length of time for all hormonal medication because we know that hormone sensitive cancers can recur years after a diagnosis. In fact, half of all recurrences occur 8 years from initial treatment. We are also giving Tamoxifen for a few years followed by an aromatase inhibitor for a total of 5-8 years of treatment. This allows women to be exposed to less of the side effects of both drugs.
Should we extend it to 10 years, 15 years, forever…?
Women treated for breast cancer at Hudson Valley Hospital Center will have more choices thanks to a $150,000 grant the Hospital is to receive from New York State with the help of Senator Greg Ball. The money will help to pay for equipment that will allow the Ashikari Breast Center at Hudson Valley Hospital Center to perform intra-operative radiation on women undergoing breast cancer surgery. The procedure will be available to patients starting the second week in November.
“The Ashikari Breast Center at Hudson Valley Hospital Center offers women the best cancer care close to home,’’ said breast cancer surgeon Dr. Andrew Ashikari today at a press conference at the Hospital. “Now women who could benefit from intra-operative radiation don’t have to travel elsewhere to get it. This is a great addition to the Hospital and a victory for women with breast cancer.’’ “Not everyone is a candidate for IORT, but in many women undergoing a lumpectomy it provides a less stressful option to traditional whole breast radiation treatments,” said Dr. Pond Kelemen .
Sen. Greg Ball said he was happy to advocate for his community in Albany.“The stresses associated with battling breast cancer are overwhelming and providing world class services locally, without the additional stress of travel and hardship of leaving the familiarity of their community is exactly why I couldn’t be happier to deliver this $150,000 grant to the Hudson Valley Hospital Center. I am proud to assist in making the Cheryl R. Lindenbaum Cancer Center the destination of choice for cancer patients in the Hudson Valley,” said Senator Greg Ball. “It is a great honor to be able to deliver this money for the hard working doctors, nurses, staff and the entire Hudson Valley Hospital Center community, especially as we embrace the struggles of our
Intra-operative radiation (IORT) allows selected breast cancer patients undergoing breast preservation surgery to receive one dose of radiation while asleep during surgery, compared with 6-1/2 weeks of radiation after surgery. In higher risk patients, it is used to boost the surgical cavity with radiation to reduce the post-op radiation to only 5 weeks. Women who undergo IORT only and develop a recurrence can then undergo a repeat lumpectomy and whole breast radiation, while those who get standard radiation and develop a recurrence are recommended to have a mastectomy. The Ashikari Breast Center has participated in the largest international trial of IORT and will be active in the American trial, which will begin soon.