Many patients with a common form of breast cancer might not need to go through chemotherapy, according to a recent study co-authored by Kathy Albain of Loyola University Medical Center.
The New England Journal of Medicine published the study, titled “Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer” — which found chemotherapy wasn’t effective for 70 percent of women observed in the study.
Breast cancer is a common form of cancer which affects both women and men. About 89 percent of breast cancer patients survive five or more years after diagnosis, according to the National Cancer Institute, which funded the study.
Albain is an oncologist at the Loyola University Medical Center and a member of the committee overseeing the study. She joined Loyola’s medical campus in Maywood as a professor and physician in 1984. Albain said she’s also considered an expert on the 21 gene test, which is conducted on a tumor to determine the risk of breast cancer recurring in the patient on a scale of zero to 100.
Albain said scores up to 11 on the 21 gene test are considered low, and scores greater than 25 are considered high. Patients with a low score don’t need chemotherapy, but for patients with higher scores, chemotherapy is a recommended treatment.
Chemotherapy is a common cancer treatment, but fatigue is its most common side effect. It can lead to exhaustion and weaken the body, according to the National Cancer Institute. Chemotherapy also can cause nausea, hair loss and sleep problems.
However, not all patients’ scores fit the high and low categories, according to Albain. This makes determining necessary treatments difficult.
“The problem is the majority of women’s scores end up in the middle range where maybe there’s a benefit to chemo,” Albain said. “[The benefit] may be small … you have to explain all that to the patient and say ‘until we can do a study in thousands of women where we’re going to have a good statistical power to answer it, we’re not going to know what to do with these scores between 11 and 25.”
Jennifer Mall, a mother of three from Downers Grove and one of Albain’s patients, fell into that category when she was diagnosed at 39.
“It was a little disheartening that I fell right in the middle where they didn’t really know if chemo would be beneficial,” the 47-year-old said. “I had a score of 17 which was smack dab in the middle of that range.”
Mall said she joined the study in 2010 per Albian’s suggestion.
The study observed 10,273 women with hormone-receptor-positive, human epidermal growth factor receptor 2 (HER 2)-negative, axillary node-negative breast cancer — the most common form. This form of cancer is found in patients with their estrogen receptor on, HER-2 receptor off and cancer-free lymph nodes, according to Albain.
The women with a mid-range 21 gene test score were divided into two groups — one group received chemotherapy and endocrine therapy while the other received only endocrine therapy. Endocrine therapy is given as a pill and affects a patient’s hormones to treat the cancer.
Mall was placed in the second group which didn’t receive chemotherapy.
The results showed both treatments had similar effectiveness and there was no added benefit to chemotherapy for most patients.
Mall said she was initially worried about joining the study since she knew chemotherapy was a common cancer treatment.
“Obviously I didn’t want to do chemo,” she said. “To not do it, it kind of played some tricks on my mind … everytime I had a cough or an ache or a pain my mind immediately went to ‘I didn’t do the chemo; the cancer is back.’”
Now, Mall said she was happy about the study’s outcome.
“It makes me feel really happy that there’s multitudes of women that can avoid that uncertainty and get a treatment plan for them that the doctor is confident about,” Mall said.
The study also opens up new opportunities for further research into cancer treatment and predicting long-term recurrence. Albain said researchers will continue to follow the women who participated in the study and use their blood and tissue samples for further research.
“The study will keep on giving many times over the years,” Albain said.