‘Less is more’: Research shows more breast cancer treatment isn’t always better
When Margaret Lopreiato was first diagnosed with breast cancer, her family history of cancer didn’t render her surprised, however, the feelings of fear and uncertainty still made an appearance.
“I knew in my family history, we saw somewhere along the line, we’ve got cancer,” says Margaret, whose father passed away from throat cancer, and mother had bladder and bowel cancer before passing away.
Margaret’s older sister has battled leukemia as well, and her two nieces have been diagnosed with breast cancer.
Thankfully, the three of them are fine now, Margaret says, but unfortunately, the cancer journey is not a new thing for her.
Margaret was 50-years-old when she went to get a breast screen, which led to a biopsy, and ultimately, a doctor told Margaret that she had breast cancer. She was diagnosed with Stage two, hormone positive and HER-2 positive breast cancer.
Margaret Lopreiato
Margaret received surgery to remove a lump in her breast, and that’s when her doctor, Dr Bruce Mann, looked at her tissues to determine that she was a candidate for the PROSPECT clinical trial.
PROSPECT is a clinical trial which will use a new technology, breast magnetic resonance imaging (MRI), in combination with review of pathological features of the breast tumour to prospectively identify women who can safely avoid radiotherapy because their risk of local recurrence is very low.
Now that Margaret has participated in PROSPECT and completed her 10-year surveillance last year, she reflects on her experience saying that “chemotherapy was bad enough” and she knew that she didn’t really want to do the radiotherapy, so she went ahead with the trial.
“There’s something I don’t have to worry about,” she remembers thinking when she found out she wouldn’t have to undergo radiotherapy.
“It was easing my mind that I didn’t have to do it,” she says, noting that this helped her to “concentrate on the chemotherapy” and not have the radiotherapy affecting her personal and professional life as well.
Rethinking breast cancer treatment
As medical knowledge of breast cancer continues to grow, research has been showing that providing more treatment isn’t always the best approach.
It’s a common myth that more treatment is better for breast cancer, but researchers are investigating if a ‘less is more’ approach will give patients equally good or better outcomes.
This is great news for patients as a whole, because reducing the amount and intensity of treatment that patients receive has the potential to reduce the side effects of treatment, which can often be long lasting.
Each person’s cancer journey is unique, so this optimised treatment means moving away from a one size fits all approach to breast cancer treatment, towards better tailoring of treatments for patients. It may also provide doctors not just the knowledge on how to treat the disease but how to better care for the patient as a whole.
OPTIMA clinical trial
Aiming to identify if breast cancer patients may be able to avoid chemotherapy altogether, OPTIMA is a promising international clinical trial that has made its way to Australia, with a potential for big impacts towards a ‘less is more’ approach.
The Australian principal investigator of OPTIMA, Dr Belinda Kiely says “the main treatment for hormone positive early stage breast cancer is hormone blocking tablets. And we know they work quite effectively. But in someone who’s got a high risk hormone receptor positive breast cancer, we actually recommend they have the hormone blocking tablets, plus they have several months of chemotherapy.”
Chemotherapy, however, has many side effects such as nausea, tiredness, hairloss as well as longer term problems that can affect people’s concentration, their sleep, their weight, they can get peripheral nerve damage in their hands and feet, Dr Kiely says.
“There’s a lot of reasons why we try and not give chemo if we don’t have to.”
Dr Kiely is a Medical Oncologist who specialises in the treatment of people with breast cancer. She works at Campbelltown and Concord Hospitals in Sydney and is actively involved in breast cancer research, with a particular interest in prognosis, survivorship and symptoms of menopause.
“The idea of the Optima trial, which we’re running in Australia, and that I’m leading,” she says, “is to try and work out if we can do a test on these women with high risk hormone positive breast cancer to work out which of those women has a lower risk of the cancer returning and therefore could safely be spared the chemotherapy and just treated with the hormone blocking tablets.”
Dr Belinda Kiely
While the OPTIMA trial has been open internationally for many years now, it only just opened in Australia at the beginning of this year.
This is significant because, unlike countries such as the US, UK, Ireland, Canada and Germany, certain tests to determine the risk of cancer are not able to be reimbursed in Australia, meaning patients must pay out-of-pocket.
“So, if I see a patient and I want to do a test to work out how risky their cancer is, their out-of-pocket [cost can be] anywhere from three to $5,000,” Dr Kiely says.
“And the reason that the government in Australia isn’t funding these tests is they’re not convinced there’s enough evidence [that the tests are] just as safe as what we do already where we give everybody chemotherapy.”
Therefore, researchers in the OPTIMA trial are working to improve access to Australian patients by providing evidence that shows minimising chemotherapy in people with a lower risk disease is a safe and effective option, in the hopes that the government provides funding for the tests.
“The main benefit of that for women is they can be spared or the side effects that I was talking about,” says Dr Kiely, noting that “a lot of women have to stop work to have chemotherapy, it has a big impact on their lives at home with their families, looking after their kids.”
“The side effects can really cause a lot of other issues with their lives and so we could actually reduce a lot of that impact by not giving everybody chemotherapy– only selecting out the ones that really need it.”
“We’re not saying that no one needs chemotherapy. What we’re trying to work out is a way that we can [understand] who needs it, and make sure they get it, [but also] who’s going to do well without it.”
Join Breast Cancer Trials on Wednesday 12 June from 5-6:30pm (AEST) for a free online Q&A, where leading researchers and women with a history of breast cancer will discuss a ‘less is more’ approach to treatment. The session will be moderated by author and journalist Annabel Crabb. To register click here.
The post ‘Less is more’: Research shows more breast cancer treatment isn’t always better appeared first on Women's Agenda.
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