Wednesday, October 15, 2014

A New Cure for Breast Cancer - Early Detection

Breast cancer is the 2nd deadliest cancer in women, so it was interesting to come across a research article claiming to have found a cure. Was it a new pill, a new chemotherapy, or new surgical technique? It turns out to be none of the above, but rather the simple, but challenging principle of early detection. 

In very early breast cancer, usually the best treatment is surgical excision, but when the cancer has spread, chemotherapy and sometimes radiation therapy or additional surgery is necessary. This latest research study, published April 25, 2012 in the peer-reviewed journal Breast Cancer, looked at women who had early metastatic spread of the disease to the lymph nodes, bones , the liver, or other organs. And guess what? They found what essentially is a cure, meaning a relapse-free survival of over a decade. 

The researchers theorized that since only about 2% of women with metastatic disease survive relapse-free for 10 years or more, that looking at these 2% who are long-term survivors might provide some clues into what works. They therefore looked at 75 women with early metastatic disease, defined asoligometastatic breast cancer. These women in general were treated with systemic chemotherapy and as appropriate, surgical or radiation therapy. 

Chemotherapy lead to either a complete or partial response in nearly all of the 68 patients studied (an overall response rate of 95.6%). Response rates were better in women where the breast cancer had spread to only a single organ. Local therapy, such as additional surgery or radiation therapy, was associated with improved overall survival and relapse-free survival. 

The conclusion of this study is that aggressive treatment of oligometastatic breast cancer seems to lead to improved outcomes. If the cancer can be caught very early in the breast, it can be cut out and survival is excellent. If the cancer has already spread, but only to one or two organs such as to the bones or the liver, then aggressive treatment including additional surgical or radiation therapy seems to make a big difference. Catching the disease early can means a survival rate of over 50% at 10 years, but if the metastatic spread isn't caught until later, the relapse-free survival rate at 10 years is under 5%. 

This is very encouraging news, because it identifies a group of women with metastatic breast cancer that have a very good chance of long-term, relapse-free survival. It also is encouraging because it suggests that for patients, chemotherapy is worth it, and the additional radiation and surgical therapies also seem to make a big difference. 

Like just about everyone, I have several good friends with breast cancer, because after all, the disease affects about 1 out of every 8 women. It can be deadly, but even people with advanced spread of the disease can experience survival rates of over 50% at 20 years after diagnosis-- but only if the metastatic disease is caught early, when it is still oligometastatic. As a physician, the take-home message is that early detection of metastatic disease may greatly increase the chances of long-term survival. If metastatic disease is detected early, then there is great hope for beating the disease and living healthy for two decades and longer.