The largest ever analysis of the use of chemotherapy for breast cancer has shown that these cancer-killing drugs can benefit a wider range of patients than previously thought.

The study, involving 18,000 patients, was published in The Lancet on 18 September. It showed that women with breast cancer may benefit from chemotherapy:

* even if the cancer has not spread to their lymph glands,
* even if they are over age 50, and
* whether or not the cancer is hormone-sensitive.

Among women under age 50 whose cancer had spread to the lymph glands at the time of surgery, chemotherapy typically prevented about 11 deaths during the next 10 years for every 100 women treated. Among younger women with no evidence of disease spread to the glands, there were about seven fewer deaths. And among women in their 50s and 60s about 2-3 lives were saved for every 100. Using more than 3-6 months of chemotherapy did not show any additional benefit.

These results are important although not surprising to specialists – many of whom already treat a number of these groups with chemotherapy. But combining 47 properly managed, randomised trials in this study has provided a huge database which means that there is no doubt these results are real. Chemotherapy has definitely enabled these patients to live longer.

‘I would recommend anyone diagnosed with cancer to ask their doctor, “Is there a role for chemotherapy in my treatment?”,’ says Dr Hilary Thomas, cancer specialist at Royal Surrey County Hospital, Guildford. Not that she would try to persuade a patient to take any particular form of treatment: ‘This isn’t a massive leap forward, a lot of these results show relatively small benefits, but they are significant. In any case it’s not up to us doctors to play God.

‘We explain the statistics to the patient and help them decide. The emphasis should always be on the doctor and patient agreeing on the most suitable treatment.’
Less toxicity

‘There’s something of an anti-chemotherapy culture in the USA, which is regrettable,’ she says. However, she feels the tide has been moving steadily in favour of chemotherapy in recent years. As The Lancet study has shown, the benefits are becoming more apparent for more groups of patients. In addition, ‘as our experience has built up, oncologists have found ways of avoiding the toxicity [side effects], which enables patients to get on with their lives. We have better anti-sickness drugs, we are getting much better at preventing hair loss with certain drugs, and we can often adopt drug schedules that mean four visits to hospital, say, instead of 12 as it was in the past.