In the last couple of months there have been stories splashed all over the media about a recent federally funded study that found chemotherapy showed no benefit in certain breast cancer patients. We saw the “70% of the most common type of breast cancer” headlines everywhere. Is this good news? Absolutely. But there are many different types of breast cancer. Most people outside the breast cancer community do not know this. I didn’t prior to my own diagnosis. I wish more of the news outlets would not have left out details for the sake of a sound bite. What they are referring to is the Trial Assigning Individualized Options for Treatment (Rx), or TAILORx trial which found that those breast cancer patients who are early stage, i.e. 1 or 2, axillary lymph node–negative, estrogen and progesterone positive, and HER2 negative, may not benefit from chemotherapy, as previously thought. These are women who had an intermediate Oncotype (Oncotype DX Breast Recurrence Score) which assesses the expression of 21 genes associated with breast cancer recurrence to assign women with early-stage, HR-positive, HER2-negative, axillary lymph node–negative breast cancer to the most appropriate and effective post-operative treatment. These were the women on the borderline and this trial made the choice for or against chemotherapy much easier, really a slam dunk. For these women this is great news, important news. But where is the good news for the later stage and stage IV patients? From metavivor.org:
In the United States, someone dies from breast cancer every 14 minutes. This number has not decreased significantly in nearly 40 years despite a huge movement to raise awareness and funds for breast cancer research. Just wearing, buying, or even walking for “pink” does not reduce deaths from breast cancer. Scientists know that research specifically focused on metastasis is crucial to significantly reduce the breast cancer mortality rate. Metastasis research is challenging for various reasons. However, the biggest obstacle is lack of funding: only an estimated 2-5% of the funds raised for breast cancer research is spent on studies of metastasis.
Each year, 200,000 Americans are diagnosed with breast cancer. Six to ten percent of these diagnoses are metastatic, or stage 4. Another 30% progress from stages 0, 1, 2 and 3 to develop stage 4 – maybe immediately, maybe 30 years down the line. Science has very few answers to the reason why cancer metastasizes and we don’t yet have an effective treatment to arrest metastatic growth. What we do know is that a diagnosis of Stage 4 breast cancer is not considered survivable and that almost 40,000 men and women die of it each year.
2-5% of research funds is spent on studying Metastatic Breast Cancer or MBC. That is obnoxious. I am not a pink-hater. I think the pink movement is important and necessary, but what angers me is that too many companies and consumers buy into the pinkwashing movement and don’t understand where the money is actually going. Awareness is important but so is NOT DYING.
So when we talk about the TAILORx study I realize that those outside the breast cancer world likely have no idea what I’m talking about. And they would also see the 70% figure and think okay, so 70% of breast cancer patients do not need chemotherapy now. WRONG. 70% of the most common type implies 30% of those that fall into that lucky group will not benefit and then you have all the other patients who do not fall into that category at all. It’s almost like saying “if you are right handed with medium sized fingernails and wear a ring size of 6-8” you will qualify. That might apply to most women but think about how many it doesn’t. I do not want your eyes to glaze over but here is a quick primer on breast cancer. First, below are the different types.
- Ductal Carcinoma In Situ (DCIS)
- Invasive Ductal Carcinoma (IDC)
- IDC Type: Tubular Carcinoma of the Breast
- IDC Type: Medullary Carcinoma of the Breast
- IDC Type: Mucinous Carcinoma of the Breast
- IDC Type: Papillary Carcinoma of the Breast
- IDC Type: Cribriform Carcinoma of the Breast
- Invasive Lobular Carcinoma (ILC)
- Inflammatory Breast Cancer
- Lobular Carcinoma In Situ (LCIS)
- Male Breast Cancer
- Molecular Subtypes of Breast Cancer
- Paget’s Disease of the Nipple
- Phyllodes Tumors of the Breast
- Metastatic Breast Cancer
Breast cancer is further divided into hormone receptor and HER2 Neu categories. What I mean by this is a tumor is either estrogen/progesterone positive or negative to varying degrees. HER2 Neu is a gene that produces a protein which acts as a receptor on the surface of cells. These receptors are very sensitive to hormonal/chemical ‘growth’ signals in the body and are therefore growth factors. If the cancer tumor cells have more of these HER2 proteins than normal, that means those cells are receiving more ‘messages’ to grow and divide than normal cells. It is aggressive.
Beyond these factors, breast cancer tumors are also given a grade, either 1, 2 or 3 (3 being the fastest growing). Tumor Grade indicates what the cells look like and gives an idea of how quickly the cancer may grow and spread. Grading for non-invasive breast cancers such as ductal carcinoma in situ (DCIS) is different, and is defined as low, medium or high grade rather than 1, 2, or 3. Generally speaking, the higher the grade of tumor, the poorer the prognosis.
The last category I am going to cover is stage. With breast cancer there are stages I through IV – IV being metastatic breast cancer which is breast cancer that has spread to other parts of the body. This means if breast cancer has spread to your lungs or bones, it is still breast cancer, not lung or bone cancer. Within stages I and II there are sub stages A and B. With stage III there are sub stages A, B and C.
So now let’s revisit the study. It helps “early-stage, HR-positive, HER2-negative, axillary lymph node negative” breast cancer only. Many breast cancer patients are left out of that specific group, including me as I was Stage III. While the study bears promise for those who fit that specific criteria and I am in no way trying to downplay it’s importance, we cannot sit on our laurels and tell ourselves that nobody needs chemo anymore. Plenty of us still need chemotherapy. We also must not forget about the ladies living with Stage IV who are often on maintenance chemotherapy for the rest of their lives. We call them survivors and thrivers and IT IS TIME FOR A CURE because they are the ones dying.
Sources: National Cancer Institute, American Cancer Society, Metavivor.Org
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