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Most women with smaller breast cancer tumors can safely skip chemo, study finds

New findings show women with early stage breast cancer can avoid chemotherapy. Researchers now say most women with smaller tumors can safely skip the treatment and avoid side effects like fatigue and nausea. Amna Nawaz learns more from Dr. Larry Norton of Memorial Sloan Kettering Cancer Center.

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  • Amna Nawaz:

    New findings show women with early stage breast cancer can avoid chemotherapy. The question of whether to be treated with chemotherapy is a key question women face after surgery and hormone treatment.

    Researchers now say most women with smaller tumors can safely skip chemo and avoid its side effects, such as fatigue and nausea. The findings may change clinical practice for as many 70,000 women a year in the U.S.

    Dr. Larry Norton is a leading breast-cancer specialist and senior vice president of Memorial Sloan Kettering Cancer Center, which participated in the study.

    Dr. Norton, thank you your time.

    Can you just tell us, big picture, off the bat now, why is this such an important breakthrough?

  • Dr. Larry Norton:

    Well, now we know that we can identify patients who have a very good prognosis and don't need chemotherapy. So these patients will be spared chemotherapy. That's a wonderful, wonderful result.

  • Amna Nawaz:

    And you're able to know this now because of a gene test. You can kind of assess people's risks. And you're talking about women with what you call intermediate risk.

    Explain to me what that means.

  • Dr. Larry Norton:

    Yes.

    Well, we do this test of 21 genes. It's called the Oncotype DX test. And it tells us a scale from zero to 100 which relates to the risk of the cancer spreading to another part of the body. Very low scores, up to 10, it's a very low chance that these patients get hormone therapy, and chemotherapy doesn't help them. We have known that for a long time.

    Very high scores are at increased risk of the cancer spreading, and those patients have benefited a lot by chemotherapy. And we have known that also. But the intermediate patients with scores of 11 to 25, we have not known what's best for them. Should we give them chemotherapy? Should we not give them chemotherapy? What is the best option for these individuals? We haven't had guidance.

    Now we do. This very large, very important study is telling us that people with those intermediate scores have a very good prognosis and that prognosis is not improved by chemotherapy. So they don't have to receive chemotherapy.

    And that's just a wonderful thing, to look somebody in the eye and say, you have got a great prognosis. Your odds of being cured are terrific, and you don't need chemotherapy because you don't need it. You have got a great prognosis and chemotherapy won't help.

    It's a wonderful thing to be able to look somebody in the eye and give them that information.

  • Amna Nawaz:

    Dr. Norton, help me understand. For all the women who have been following standard practice up until now and were receiving chemotherapy who you now say wouldn't have needed it, was there a risk associated with being overtreated?

  • Dr. Larry Norton:

    Well, I mean, it depends on the chemotherapy they received. With some chemotherapies, there is a slightly increased risk of some bad effects. With other chemotherapies, such as the one we have been using at Memorial Sloan Kettering, which is the CMF combination, there's no evidence of long-term toxicity.

    So there's some variation in that regard. But the risks are very small. The long-term risks are very small. And the people that I have spoken to who, in this trial, randomized to get chemotherapy are feeling good about these results, because they had the chemotherapy. They're disease-free. It hasn't hurt them.

    But they have helped thousands and thousands of other women. Maybe 100,000 women per year, in the United States alone, are going to benefit from these results. And people are very altruistic. The volunteers in this trial are altruists. They're real heroes.

    And they have made a massive contribution to helping people with cancer throughout the world.

  • Amna Nawaz:

    Dr. Larry Norton, thanks for your time.

  • Dr. Larry Norton:

    My pleasure. Thank you.

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