New breast cancer test could spare women chemotherapy

New breast cancer test could spare women chemotherapy

Thousands of women with breast cancer could be spared chemotherapy following NHS approval of a test which can help establish who needs the treatment and who might not.The first step in treatment for breast cancer is surgery to remove tumours and chemotherapy is recommended for women whose doctors believe there is a risk that the cancer will return.But the toxic nature of chemotherapy, where side-effects can include nausea, vomiting, insomnia, hair loss and fatigue, is often gruelling for patients.

Research, carried out by Simon Holt, a breast surgeon at the Hywel Dda local health board, in Wales, showed that about half the women who undergo chemotherapy at the moment could be spared it.The National Institute for Health and Clinical Excellence (Nice) has approved a test that will help doctors to decide whether the treatment is necessary.Carole Longson, director of Nice's health technology evaluation centre, said: "Breast cancer patients face significant emotional and psychological strain when considering chemotherapy. A test that can help to predict better the risk of the breast cancer spreading, and therefore the potential likely benefit of additional chemotherapy, represents a significant step forward for patients."

Three tests were investigated by Nice. But only one, the oncotype DX test, was approved – for women who have oestrogen receptor positive (ER+), lymph node negative (LN–) and human epidermal growth factor receptor 2 negative (HER2–) in early breast cancer.There was not enough evidence to show the other two tests were useful enough for routine use, said Nice, so for the time being these will only be used in research. More than 42,000 women were diagnosed with breast cancer in 2010 in the UK, most of them at an early stage. The test will be used by doctors, in combination with other evidence such as the size and the stage of tumours, to help make a decision on chemotherapy.

There is evidence that some women are under-treated and others are over-treated at the moment.Some patients appear to have a "good" cancer, but it returns in spite of surgery and drugs. Others seem to be high risk but the cancer does not come back.Fifteen studies on more than 6,000 patients worldwide have taken place using oncotype DX, showing that about a third of treatment plans are altered as a result of the test.

The research by Holt involved 142 NHS patients with oestrogen receptor positive breast cancer, the most common type.Commenting on the Nice announcement, Kathi Apostolidis, vice-president of the European cancer patient coalition, based in Brussels, said: "The decision of whether or not to undergo chemotherapy is an extremely important and difficult one for patients, not only due to the many side-effects associated with treatment, but also due to the hardship for the patient and family and the loss of income due to days off work."Allowing patients and their physicians to make more personalised treatment decisions can help improve outcomes for the rising number of early-stage breast cancer patients in Europe."

Delyth Morgan, chief executive of Breast Cancer Campaign, said: "Today's announcement from Nice is a step along the road towards personalised treatment, and good news for women at 'intermediate risk' of their breast cancer coming back who face uncertainty around how likely they are to benefit from chemotherapy."However, like many advances in treatment, there is still much more to learn and it is reassuring to see that Nice is calling for further research into oncotype DX and other related tests to definitively determine their benefit."

A survey by the charity Breast Cancer Care, meanwhile, has found that most sufferers say the disease has had a damaging long-term impact on the way they feel about their body. Some say it has affected their sex lives.In a poll of more than 600 people, 72% said it had left them feeling less confident about their body. Many had experienced lower self-esteem, 52% said they felt uncomfortable undressing in front of their partner, and 64% of those who were single said it had a negative impact on their feelings about possible relationships.

By Sarah Boseley

The Guardian, 26th September, 2013

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