||Conquer Cancer Health News
Test may help rule out need for chemotherapy in early breast cancer
SAN FRANCISCO (AP)
Many women with early-stage breast cancer might
be spared unnecessary chemotherapy if doctors check their tumors for proteins
that help reveal whether the disease will spread.
Testing for these proteins is already becoming routine in Europe, but doctors in
the United States say they need more evidence that the approach actually works.
About 175,000 women will be diagnosed with breast cancer in the United States
this year. Most will have small tumors that have not yet spread to the lymph
nodes. About 70 percent of these women can be cured with surgery and
However, cancer will come back in the other 30 percent. Giving chemotherapy
to these women can reduce this risk by about one-third.
The problem for doctors is trying to identify this minority who need
In general, doctors recommend treatment with the drug tamoxifen for those
whose tumors are fueled by estrogen, and they urge chemotherapy for those
who tumors are larger than two centimeters, or about an inch.
Proteins as predictors
On Monday, at a meeting in San Francisco of the American Association for
Cancer Research, Dr. Anita Prechtl of the Technical University in Munich
described the use of two proteins in tumors that might help reveal their likelihood
of coming back.
The proteins are uPA -- short for urokinase-type plasminogen activator -- and its natural inhibitor, known as PAI-1. About 45 percent of breast cancer patients
have high levels of these proteins. They have a higher risk of cancer spread,
even though their lymph nodes seem free of cancer.
Prechtl's study involved 684 women whose breast tumors ranged up to five
centimeters in size but had not spread to their lymph nodes. Those with low
levels of uPA and PAI-1 were given no further treatment. Those with high levels
were randomly assigned to get no more treatment or to receive a combination of
three chemotherapy drugs.
After nearly three years of follow-up, cancer had come back in 7 percent of
women with low levels of the protein. Among those with high levels, it had
returned in 12 percent receiving chemotherapy and in 18 percent in the untreated
However, breast cancer can come back after many years, and doctors plan to
follow the women for 10 years to see if the proteins continue to help predict
By testing for the two proteins, "more than half of all node-negative breast
cancer patients can be considered as a low-risk patient group with less than 10
percent probability of disease recurrence," Prechtl said.
The study was financed by the German Research Association and the test's
maker, American Diagnostica Inc. of Greenwich, Connecticut.
Caution in U.S. medical community
Dr. Karen Antman of Columbia-Presbyterian Medical Center in New York City
cautioned that the test results need to be confirmed in larger studies before it
becomes part of routine care.
While doctors would like to spare the majority of node-negative breast cancer
patients from going through chemotherapy, she said, they fear missing those
who might benefit.
Dr. Carlos Arteaga of Vanderbilt University said that even if the test proves out,
U.S. doctors will still probably want to offer chemotherapy to node-negative
patients with tumors larger than two centimeters.
Still, he said, the study's results might eventually apply to many women. "The
majority of breast cancer patients are node negative, and a large proportion of
them are under two centimeters," he said.
UPA and PAI-1 are also being tested as possible ways to assess the outlook of
patients with ovarian, prostate and digestive system cancers, among others.
Research suggest these proteins increase the tendency of cancer to spread
throughout the body.