"Systemic adjuvant therapy" are treatments -- hormonal therapy, chemotherapy, and targeted therapy -- given after breast cancer surgery to lower the risk of the cancer coming back (recurrence). The treatments are systemic because they involve the entire body, not just the area where the cancer was.
Many, but not all, women get one or more systemic adjuvant treatments as part of their overall treatment plans for early-stage breast cancer. Systemic adjuvant treatments may not be prescribed for women considered to have a low risk of recurrence.
The results of a large analysis suggest that most women diagnosed with early-stage breast cancer who have a low recurrence risk are likely to benefit from systemic adjuvant treatment, especially adjuvant hormonal therapy if the breast cancer is hormone-receptor-positive. The research was published online Aug. 31, 2011 by the Journal of the National Cancer Institute.
The researchers reviewed women's medical records available through the Danish Breast Cancer Cooperative Group (DBCG). Because people in Denmark receive healthcare through a national health system, their health records are maintained in one large database.
The researchers looked at the outcomes of 3,197 Danish women diagnosed and treated for early-stage breast cancer. The women all were considered to have a low recurrence risk based on the characteristics of the cancer, including small tumor size and no spread to nearby lymph nodes. None of the women were treated with systemic adjuvant treatment. The average follow-up time was nearly 15 years. The researchers compared the survival of these women to the expected survival of similar women never diagnosed with breast cancer.
Overall, survival was 32% lower in the women diagnosed with early-stage breast cancer compared to the similar, never-diagnosed women. This worse survival suggests that the women's recurrence risk may have been higher than believed when treatment decisions were made. It also suggests that the women may have benefited from systemic adjuvant treatments.
The researchers looked to see which groups of women were most likely to have worse survival (compared to women never diagnosed with breast cancer). The following characteristics were linked to worse survival among women diagnosed with breast cancer who didn't get systemic adjuvant treatment:
- younger age at time of diagnosis and surgery
- cancer tumor larger than 10 mm (about 4/10ths of an inch)
- lobular breast cancer (ILC) rather than ductal breast cancer (IDC)
Women aged 60 or older when diagnosed with a small (10 mm or less) hormone-receptor-positive tumor had survival rates comparable to survival rates for women never diagnosed with breast cancer -- even though they didn't get systemic adjuvant therapy.
Based on the results, the researchers believe systemic adjuvant treatment -- particularly hormonal therapy if the cancer is hormone-receptor-positive -- may make sense for most women diagnosed with early-stage breast cancer, even if the risk of recurrence is considered low. Women aged 60 and older diagnosed with small, hormone-receptor-positive breast cancer considered to have a low risk of recurrence is the only group of women who probably don't routinely need systemic adjuvant treatment.
If you've been diagnosed with early-stage breast cancer, your doctor will work with you to create a treatment plan that makes the most sense for you based on your specific situation and the cancer characteristics identified in your pathology report. In addition to surgery, the plan might include:
- neoadjuvant treatment: chemotherapy, hormonal therapy, and/or a targeted therapy BEFORE surgery to weaken or shrink the tumor and reduce the risk of recurrence
- adjuvant radiation therapy: radiation therapy AFTER surgery, especially after lumpectomy, to reduce the risk of localized recurrence
- systemic adjuvant treatment: chemotherapy, hormonal therapy, and/or a targeted therapy AFTER surgery
This study suggests that many women considered to have a low risk of recurrence after surgery could still benefit from systemic adjuvant treatment, especially hormonal therapy if the cancer is hormone receptor positive.
If you've been diagnosed with early-stage breast cancer and your doctor doesn't recommend any systemic adjuvant therapy after surgery, it's a good idea to ask your doctor about the factors that were considered in making that decision. If adjuvant hormonal therapy but not adjuvant chemotherapy is recommended, it's a good idea to ask about the factors that were considered in making that decision.
You also may want to ask your doctor if a genomic assay was done, or should be done, on the cancer tissue. Studies have shown that adjuvant chemotherapy benefits only a small number of people diagnosed with early-stage breast cancer. A genomic assay can help identify who those people are. A genomic assay is a test that uses a sample of breast cancer tissue to analyze the activity of a group of genes in the cancer cells. Knowing whether certain genes are present or absent, or overly active or not active enough, can help doctors predict the risk of the breast cancer coming back. This can help make treatment decisions, such as whether or not adjuvant chemotherapy should be part of the treatment plan.
Armed with the best available information about the breast cancer, you and your doctor can make the treatment decisions that make the most sense for you and your unique situation.