I often experience women who come to my clinic and tell me that their friend was diagnosed with breast cancer and was treated with a pill. They ask me, “Why am I getting chemo and not the pill?”
Breast cancer is now divided into molecular subsets based on the receptors and proteins expressed on the breast cancer cells. Most of the cancers express estrogen and progesterone receptors and can be treated with only a pill. However, if they are aggressive they may require chemotherapy, especially if the growth rate of the cancer cells is high.
Similarly, triple negative, which means all receptors are negative, and HER-2 positive, which expresses the HER-2 protein, are treated with chemotherapy and Herceptin (antibody to HER-2) respectively. These cancers are aggressive tumors.
We sometimes do a 21 gene assay test on the tumor block (biopsy tissue) to characterize the cancer into a low-, intermediate- or high-risk category that may guide us as to whether to avoid chemotherapy in certain cases.
It is also important to understand that the aim of the treatment is different in early-stage breast cancer. Early stage is when the cancer is detected early and is confined to the breast tissue only.
But when the tumor spreads to the lymph nodes or even outside the breast, the prognosis becomes worse. In stage-four disease our aim is to prolong life and still maintain a good quality.
After determining the stage of the breast cancer, a plan of treatment is devised. If a patient is a candidate for chemotherapy, we are always attempting to find answers to provide better treatment options and minimizing toxicity through innovative clinical trials partnered with Fred Hutchinson Cancer Research Center and major pharmaceutical companies.
Women should be aware of their breast cancer risk, just as they know their blood pressure, cholesterol and weight risk. Studies show that fewer than 1 in 10 women have an accurate understanding of their breast cancer risk. Most women underestimate their risk for breast cancer, and they probably don’t get the necessary or most accurate screenings.
So it is extremely important to be updated on your mammograms and report suspicious symptoms or signs such as a breast lump, mass or nipple discharge immediately to your physician. Your physician can guide you to the next appropriate steps.
Dr. Namrata Sethi is a medical oncologist at Providence St. Mary Regional Cancer Center.