The Washington Post
Long-term breast cancer survivors who undergo chemotherapy or take the anti-cancer drug tamoxifen or both after surgery report more physical problems than do women who undergo surgery alone, according to a large study.
In the past decade it has become standard practice to treat even women with smaller tumors that have not spread to other organs aggressively with multiple therapies, particularly if they are under the age of 60. Doctors have maintained that surgery to remove cancerous tissue, followed by so-called adjuvant therapy — chemotherapy and chemopreventive drugs, such as tamoxifen — offers the best chance of achieving a cure and preventing a recurrence.
But the new study of 763 cancer-free women — conducted at Georgetown University Medical Center and UCLA’s Jonsson Comprehensive Cancer Center — found that adjuvant treatment may cause long-term physical side effects years after diagnosis while only modestly boosting the chances of remaining cancer-free.
"I was kind of surprised that there was a long-term effect from chemotherapy and tamoxifen," said Patricia Ganz, a professor of medicine at UCLA who is the lead author of the study. "But most people would never trade survival" for a potential risk of earlier death or recurrence, even with fewer side effects.
The most pronounced disparities were in the realm of physical functioning — such as the ability to exercise — and on a scale that measured overall quality of life.
Women who had surgery alone reported higher levels of physical functioning and overall quality of life than those who underwent adjuvant therapy. The latter group also reported more sexual side effects, such as pain during intercourse, than the surgery-only group.
On one scale, women in the surgery-only group scored 80.5 (50 was the median) on physical functioning, while women who had chemotherapy and tamoxifen or just chemotherapy scored 72.7. Women in the tamoxifen group scored 70.3.
Ganz said that for tumors smaller than 1 centimeter, women who undergo surgery but no other treatment may have a 90 percent chance of avoiding a recurrence, while those who opt for adjuvant therapy may boost that number to 93 percent.
Ganz said that some research suggests that women with the tiniest cancers — those smaller than 1 centimeter — could forgo adjuvant therapy without sacrificing their chance of disease-free survival. "Those people already have an excellent prognosis," she said.
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