NEW YORK (Reuters Health) - Women with breast cancer who developed anemia during chemotherapy had nearly three times the risk of local recurrence as those who did not develop anemia, according to a study published this week.
"We speculate that there may be an interaction between chemotherapy/radiotherapy and anemia," study chief Dr. Peter Dubsky, from the Medical University of Vienna, Austria, said in a statement.
"Both treatment modalities have been shown to be less effective in anemia patients. Since we do not see the effect in terms of relapse-free survival, the interaction with local adjuvant treatment may play a more important role," Dubsky added.
The results are based on a study of 424 premenopausal women with early-stage disease who were treated with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) after surgery, as part of the Austrian Breast and Colorectal Cancer Study Group Trial 5. All of the women who had breast-conserving surgery received radiation, whereas radiation was optional in women who had radical mastectomy.
The findings, appearing in the April 1st issue of the journal Clinical Cancer Research, indicate that 19.6 percent of women who developed anemia experienced a relapse during 5 years of follow-up compared with just 8.9 percent of women without anemia. This translates into nearly a three-fold increased risk of relapse in anemic patients.
Women without anemia experienced a significantly longer local relapse-free survival than women with anemia, according to the study.
Overall relapse-free survival, however, was not significantly affected by anemia status. "The effect was limited to local recurrences. Any explanation of the limit is pure speculation," Dubsky said.
No difference in overall survival was noted either, although Dubsky believes this may simply be a function of relatively small patient numbers and length of follow-up.
SOURCE: Clinical Cancer Research, April 1, 2008.
Developing anemia during chemotherapy to treat early-stage breast cancer seems to affect the risk of the cancer coming back. The small study reviewed here found that women who became anemic while getting chemotherapy after early-stage breast cancer surgery were more than twice as likely to have the cancer come back 5 years after surgery compared to women who didn't develop anemia. Almost 20% of the women with chemotherapy-related anemia had the cancer come back 5 years after surgery compared to only 8.9% of the women who didn't develop anemia.
Many women in the study were followed for more than 5 years. The researchers found that the women in the study who developed anemia had a risk of the cancer coming back at any time (including longer than 5 years after surgery) that was almost 3 times greater than the women who didn't develop anemia.
Although the risk of the cancer coming back in the breast was different, the researchers found that the risk of the cancer coming back in another place in the body (metastatic cancer) was the same for women who did and didn't develop anemia. Also, the risk of dying from breast cancer was the same for women who did and didn't develop anemia.
Chemotherapy is commonly used after early-stage breast cancer surgery to lower the risk of the cancer coming back. Anemia is a common side effect of chemotherapy, but not all women who get chemotherapy develop anemia. Radiation therapy is also used to lower the risk of the cancer coming back when a woman has lumpectomy instead of mastectomy. In addition to chemotherapy, the women in this study got radiation therapy if they had lumpectomy.
The researchers aren't sure why the women who developed chemotherapy-related anemia were more likely to have the cancer come back.
Doctors sometimes use medicines to prevent or treat chemotherapy-related anemia. This research didn't look at whether these medications could lower the risk of the cancer coming back. Even with these medicines, many women will still develop some level of anemia, which could affect their risk of the cancer coming back.
If you're getting chemotherapy after surgery as part of your treatment plan for early-stage breast cancer, talk to your doctor about anemia and steps you can take to lower both the risk of anemia and the cancer coming back. Visit the breastcancer.org Chemotherapy section to learn more about chemotherapy and its side effects.
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