Breast Cancer ChoicesTM |
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| Scrutinizing the evidence for breast cancer procedures and treatments |
| Treatment FAQ |
Key question to consider Is information patients receive based on customary, standard of care "consensus" or evidence based on overall survival statistics? |
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- My doctor gave me a pathology report listing a lot of things about the
properties of my tumor.
What do they mean?
If you choose conventional therapy, your oncologist will factor in
all the elements of the pathology report and decide on a treatment
course determined by the most recent treatment guidelines. Certain
pathology findings are examined to determine whether or not
chemotherapy will be recommended. However, many complementary
practitioners consider much of the pathology information irrelevant for
the purposes of making treatment decisions.
This reasoning is based on the poor track record of chemotherapy's
survival value for most breast cancers regardless of the findings in the
pathology report.
Usually, complementary physicians only address the tumor’s hormone
receptor status from the pathology report, and there is controversy
between practitioners about whether hormone blocking for hormone-
positive patients has any all-cause survival benefit. This controversy
arises from the volume of studies showing breast cancer patients taking
hormone replacement after their diagnosis survived as long as or longer
than those who took no hormones.
My doctor has recommended radiation to prevent recurrence
after my lumpectomy. What can I read about this?
Although it's been known for years that radiation does not offer any overall
survival advantage after lumpectomy, an article published in the
prestigious British medical journal The Lancet in 2000 shows that while it
may reduce deaths from breast cancer by 13.2%, death from all causes is
21.2 % higher in radiation-treated women. Mostly, these women die from
heart disease probably caused by radiating the chest.
There is no question that radiation will “sterilize the area” around the
tumor site and reduce local recurrence in the short term. But then
radiation-induced breakdown of the coronary arteries begins to take its
toll and overall survival statistics go south. Also, should you drop dead
from a heart attack four years after radiation treatment, you are still
counted as a breast cancer radiation success statistic since you did not
die from breast cancer.
Risks of Radiation May Outweigh Benefits in Some Breast Cancer
Patients
By Merritt McKinney [Excerpt]
WESTPORT, May 19 (Reuters Health) - A meta-analysis of randomized trials
of radiotherapy in breast cancer patients shows that the treatment is
associated with reduced local recurrence and breast cancer mortality, but
also with increased mortality due to other causes.
For older women as well as women of any age who have a low risk of
recurrence, the risks of radiation may outweigh the benefits, researchers
report in the May 20th issue of The Lancet.
Dr. Rory Collins, of the Clinical Trial Service Unit at Radcliffe
Infirmary, in Oxford, England, and other members of the Early Breast
Cancer Trialists' Collaborative Group reviewed the 10-year and 20-year
results of unconfounded, randomized radiotherapy trials that included
19,582 women. All of the trials began before 1990.
Overall, radiation prevented about two thirds of local recurrence,
regardless of patient characteristics or radiation type, Dr. Collins told
Reuters Health. According to Dr. Collins, radiation therapy appears to
translate into "moderate improvement in avoidance of breast cancer
deaths." He noted that the benefits of radiation tended to be greater in
node-positive women.
When the results of all studies were combined, women who received
radiation did not have lower breast cancer mortality in the first 2 years,
but after that, the annual breast cancer mortality was about 13% lower than
that of women who did not undergo radiation, according to the report.
Despite the reduced breast cancer mortality associated with radiotherapy,
however, overall mortality was actually higher in radiation-treated women.
Beginning 2 years after randomization, the annual non-breast cancer
mortality rate was 21.2% higher in women treated with radiation.
This increased mortality "appeared chiefly to involve an excess of vascular
deaths, perhaps due to inadvertent irradiation of the coronary, carotid or
other major arteries," the authors write. [end excerpt]
The original study referenced above:
Lancet 2000;355:1739-1740,1757-1770. [See article abstract in Medical
Studies]
My doctor has recommended chemotherapy treatment because
I "will gain a 30% benefit" from undergoing this treatment.
What does this mean?
- There are certain words used in the cancer field that can be
misleading. Two of them are “response” and “benefit.” A tumor may
shrink with chemotherapy or lower your tumor markers but not
prolong your life. When reading any study keep in mind that the
phrase, "disease-free survival" is only the amount of time until
recurrence.
- Remember to consider only "overall survival." It won't do any good
to get a 30% cancer response rate but no improved overall survival
because of a possible chemotherapy-related side effect such as
leukemia or heart disease. Check out all recommended
chemotherapy drugs on rxlist.com.
- Ask your doctor for the “overall survival” statistics for the
recommended therapy. Ask to see the published articles, the actual
studies which spell the overall survival numbers out. Put them in
your Patient Portfolio to read carefully later.
- If the doctor says you won’t understand them, you can say, “That's
okay. I have smart friends." If the doctor brings in a colleague and
they both say they would recommend the therapy for their own
daughters, you can thank them for their frankness, but get the
studies in your hands before leaving.
 | The take home question is: when your survival and quality of life are | |
| at stake do you really want to take somebody's word for it about what's good for you? Or do you want to see documented published evidence about survival advantage? |
Chemotherapy research is done drug by drug and often difficult to
evaluate. Most doctors try a “cocktail,” a combination of toxic agents
called polychemotherapy to achieve “response.” But each
recommendation you receive must be evaluated. Consider the following
study from the prestigious medical journal,The Lancet ,[highlighted
emphasis added for clarity] which factors quality of life into its calculations.
- Lancet 2001 Jul 28;358(9278):277-286
Polychemotherapy for early breast cancer: an overview of the
randomised clinical trials with quality-adjusted survival analysis.
Cole BF, Gelber RD, Gelber S, Coates AS, Goldhirsch A.
Dartmouth College Medical School, Lebanon, NH, USA.
BACKGROUND: Overview analysis involving 18000 women with breast
cancer in 47 randomised trials showed that prolonged chemotherapy
significantly reduces the risk of relapse and death compared with no
chemotherapy. Here we express the size of the benefit in terms of
quality-adjusted survival time gained. METHODS: We used the Q-
TWiST method (Quality-adjusted Time Without Symptoms of disease
and Toxicity of treatment) to provide treatment comparisons within 10
years' follow-up, incorporating differences in quality of life associated
with times patients spend with chemotherapy toxic effects, after
relapse, and without symptoms of relapse or toxicity.
FINDINGS: Within 10 years' follow-up the benefit of increased
relapse-free and overall survival for younger women (<50 years old)
who received polychemotherapy balanced the burdens in terms of
acute toxic side-effects, especially among women enrolled in trials
that did not include tamoxifen. Overall, chemotherapy-treated
younger women gained an average of 10.3 months of relapse-free
survival and 5.4 months of overall survival within 10 years (p<0.0001
for both) compared with the no-chemotherapy group.
Polychemotherapy provided more quality-adjusted time than control
across nearly all values of utility weights for time spent undergoing
chemotherapy and time after relapse. The range of benefit was from -
0.6 to 10.3 months. For older women (50-69 years) overall,
polychemotherapy also provided significant benefit compared with no
chemotherapy but, compared with younger women, the size of benefit
was less and the range of utility-weight values favouring
polychemotherapy was smaller.
Average gains for older women treated with polychemotherapy
(with or without tamoxifen) were 6.8 months of relapse-free
survival (p<0.0001) and 2.9 months of overall survival (p=0.0001)
within 10 years. The range of quality-adjusted benefit was -3.1 to 6.8
months. For older women with oestrogen-receptor-poor tumours who
did not receive tamoxifen (9% of the total), the benefit of
polychemotherapy was significant and similar to that observed for
younger women. INTERPRETATION: The benefits of adjuvant
chemotherapy within 10 years outweigh the burdens especially for
younger women (<50 years old) and among older women (50-69 years)
to a lesser degree. Additional studies to compare the quality-adjusted
survival of chemotherapy plus endocrine therapy versus endocrine
therapy alone are required for younger patients with tumours that
express steroid-hormone receptors.
- ----------------------------------------------
How can I find out about the risks of doing chemotherapy treatment?
The risks of chemotherapy are listed in the consent form that you sign
prior to starting treatment. There may be some variation with each drug
but please see a generic consent form at this link Generic Chemotherapy
Consent Form.
I have hormone receptor-positive cancer. What about Tamoxifen?
Tamoxifen has been misrepresented as a drug which will significantly
increase survival in hormone receptor positive patients. One breast
cancer activist claims it will reduce recurrence by 50%. This figure does
not reflect the actual survival statistics. Tamoxifen's manufacturer states
the difference between node-negative Tamoxifen takers and non-takers is
small. If you do the math, you will see the survival advantage for node
negative patients taking Tamoxifen is 3.5%.
That means there is a 96.5% chance that taking Tamoxifen will not increase
lifespan but will still expose the patient to risk of endometrial cancer,
depression, blood clots, vaginal atrophy, hot flashes and other side
effects.
You may want to research hormone options and tell your doctor about your
findings. Be aware Tamoxifen clearly has a documented downside. You
may want to Google Sherrill Sellman’s article, “The Dark Side of Tamoxifen”
Can I design my own alternative protocol or should I find a
practitioner to guide me?
In the first couple of years, most alternative therapy patients function best
under the guidance of an experienced practitioner. Others feel confident
to research and design their own protocols.
Has any one protocol been proven to cure breast cancer?
No. What works for one person may not work for another, whether it is
conventional or non-standard.
Somebody suggested the AMAS test to monitor the status of my
cancer.
Speaking from 13 years on the Email Group, we’ve seen a huge number
of false negatives with the AMAS test. That is, the test missed a cancer
determination when there was active, disease verifiable by biopsy or
scans.
I’ve been taking HRT. Should I stop?
The majority of studies show that taking HRT after breast cancer
diagnosis, paradoxically, does not effect survival. Click on HRT AFTER
BREAST CANCER for documentation on this and review the surprising
information with your doctor. That being said, those taking Prempro before
diagnosis appear to be at increased risk for lobular cancer. (JAMA 2003;
289:1421-1424.)
The alternative medicine community does not look kindly on synthetic
hormones and prefers bioidentical hormones when hormones are
prescribed. Taking hormones of any kind remains controversial, so review
the studies and make this choice along with your doctor.
What about Iodine, DIM, I3C, progesterone or calcium glucarate
instead of Tamoxifen for hormone modulation?
There are many strategies reputed to reduce your risk of recurrence. We
have been researching progesterone for 15 years. Check our
progesterone research page. Read up and consult a practitioner
experienced with these supplements. Also go to Healing Strategies.
- DIM and I3C are more of an idea than a demonstrated benefit. Although
there are many studies it has never been clear whether the strategies to
change the other estrogens to estriol has ever helped a woman live a day
longer with a breast cancer diagnosis. A whole testing industry has built
up around this premise.
- Calcium glucarate is another chemical which assumes mopping up
estrogen in the gut has value rather than normalizing estrogen receptors.
DIM and I3C are known thyroid suppressors which can be a risk factor
for breast cancer.
My family is pressuring me to take chemo and radiation therapy.
How have other patients handled this?
Join the an online breast cancer group for those using non-standard or
integrative therapies and ask.
Update: What is the rate of side effects for chemo?
Of 4075 breast cancer patients who had chemotherapy, roughly one in six
of these patients showed up in the emergency room or were hospitalized
due to side effects, such as low blood pressure, dehydration, or nausea.
(See Hassett M et al., Frequency and Cost of Chemotherapy-Related
Serious and Adverse Effects in a Population Sample of Women with Breast
Cancer, JNCI 2006.)
If I have chemo, will I have brain fog, called "chemo-brain"?
Update: 21 patients who had chemotherapy within the past 5-10 years were
asked to perform a short-term memory task. PET scans revealed a link
between chemo-brain symptoms and lower metabolism in the frontal
cortex. The lower the metabolism in the frontal cortex and the cerebellum,
the more difficult it is to perform a short-term memory exercise. (See
Silverman D et al., Altered Frontocortical, Cerebellar and Basal Cranial
Activity in Adjuvant-Treated Breast Cancer Survivors 5-10 Years After
Chemotherapy, Breast Cancer Res Treat 2006.)
Specifically, what is the neurological effect of taking three
mainstream chemo drugs?
Update: Taking carmustine, cisplatin, and cytosine arabinoside have been
found to be more toxic for the progenitor cells of the central nervous
system and cells that help myelinate the nervous system than they are for
multiple cancer cells lines.
(See Dietrich J, CNS Progenitor Cells and Oligodendrocytes are Targets of
Chemotherapeutic Agents In Vitro and In Vivo, Journal of Biology 2006.)
I’ve just finished chemotherapy and my tumor markers are back to
normal. Is there anything more I can do?
Congratulations on getting through your treatment. No matter what
treatment we started out with, we are all trying to prevent recurrence. You
may want to join an online group to investigate how patients try to boost
their immunity by cleaning up toxins from their households as well as their
bodies. Chlorine, fluoride, benzenes and a host of other chemicals are all
around us. Part of our clean up strategy is to reduce the toxic load on our
immune systems.
Please report dead links or suggestions about this page. Thanks in advance. |
Negative nodes?
3.5% difference
between Tamoxifen
takers and non takers
3.5% difference
between Tamoxifen
takers and non takers
Specific antibiotics sometimes used in chemotherapy regimens. On July 8, 2008, the FDA ordered a black box warning on certain antibiotic medications containing fluoroquinolone, which has been linked to tendon ruptures, tendinitis and toxicity. Included were the popular drugs Cipro, Levaquin, Avelox, Noroxin and Floxin. Many legal actions are pending regarding these drugs. |
Keep a Patient Notebook Take notes at every practitioner visit. Have a friend or family member there to take notes separately since patients may be concentrating on the interview and miss details. |
NOTE: Radiation Therapy reduces by 10% the recurrence within the breast for five years-- NOT the 40% "relative risk" figure that is usually given. Radiation Therapy provides no survival value. |
New England Journal of Medicine on Radiation Survival Statistics The National Adjuvant Surgical Breast and Bowel Project Report: After 20 years of follow up, we found no significant difference in overall survival in women wo underwent mastectomy or lumpectomy with or without post operative radiation. |
What about radiation after mastectomy? No advantage after 25 year follow up. Read the New England Journal of Medicine. |
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The purpose of patient education is to equip the patient to make informed decisions for her own treatment-- NOT to convince her doctor of the validity of her decisions. --MH |
What are the hidden statistics in treatment recommendations? How to ask your doctor for "overall survival" information. |
Dr. Eric Winer from Dana Farber Cancer Institute VIDEO From 2010: Aromatase Inhibitors as adjuvant therapy offer no survival value. |
Video has been removed |
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Recent /ongoing Tamoxifen Studies show some reduction in recurrence but no improvement in overall (all-cause) survival |
- These statements have not been evaluated by the U.S. Food & Drug Administration. The
information discussed is not intended to diagnose, treat, cure, or prevent any disease.
- This website is intended as information only. The editors of this site are not medically-trained.
Please consult your licensed health care practitioner before implementing any health strategy.
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Anti anemia drugs reported to decrease survival of cancer patients Procrit, Epogen,Aranesp |
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