Breast Cancer Test Could Remove Chemotherapy Need

breast cancer genetic

A genetic test can identify which early-stage breast cancers can be treated without chemotherapy, according to trials. 

Trials of a genetic test that works out the chances of breast cancer returning after treatment have revealed that about 70% of women with the most common form of early-stage breast cancer could be treated safely with just surgery and hormone therapy, avoiding the need for chemotherapy. 

Genetic test

Chemotherapy is often used after surgery to reduce the chance of breast cancer spreading or returning. However, side-effects range from vomiting, fatigue and infertility, to permanent nerve pain, heart failure and leukaemia. 

A genetic test (Oncotype Dx) can be used to identify whether women with early-stage breast cancer need chemotherapy. Currently, women who get a low score on the test are told they do not need chemotherapy and those with a high score are told they definitely do. 

However, there is uncertainty about how to treat those in the middle range – this trial, led by the Albert Einstein Cancer Center in New York, aimed to investigate whether these women need or could benefit from chemotherapy.

Similar survival

The trial involved nearly 10,000 women aged 18 to 75 with a common type of early-stage breast cancer called hormone receptor positive breast cancer, which had not spread beyond the breast. 

All women underwent surgery to remove as much of their tumour as possible and those in the mid-range score group (who made up about 69% of the study population) were given either hormone therapy alone or in combination with chemotherapy.

Study results revealed that hormone therapy alone was just as good as hormone therapy plus chemotherapy in the mid-range score group, and did not affect survival rates. However, women aged under 50 at the higher-scoring end of the mid-range might still benefit from chemotherapy.

Guiding treatment

Results of the trial were published in the New England Journal of Medicine. Lead author, Dr Joseph Sparano, Associate Director of Clinical Research at Albert Einstein Cancer Center, explained the implications for women with early-stage hormone receptor positive breast cancer: “Our study shows that chemotherapy may be avoided in about 70% of these women when its use is guided by the test, thus limiting chemotherapy to the 30% who we can predict will benefit from it.”

The researchers noted that this is the largest ‘precision medicine’ trial ever done and, although it only applies to one specific type of breast cancer, its promising results have the potential to help guide optimal treatment for some groups of women with this disease.


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