Whether or not patients with very small breast tumors (those of one centimeter or less) need chemotherapy or hormonal therapy after surgery is a matter of debate among breast cancer experts. Now, a new look at five earlier studies suggests that post-surgical, or adjuvant, treatment should be considered as a treatment option.
The study, led by Bernard Fisher, M.D., of the National Surgical Breast and Bowel Project (NSABP) in Pittsburgh, Penn., appeared in the Jan. 17, 2001, issue of the Journal of the National Cancer Institute.
To conduct the analysis, the researchers compiled information from five randomized clinical trials conducted by the NSABP between 1976 and 1993. The trials included a total of 1,259 breast cancer patients who had surgery to remove tumors that measured one centimeter or less, and who had no sign of cancer in the lymph nodes under the arm.
Each of the five studies had too few women in this category to fully evaluate the usefulness of post-surgical therapy. But when the information was combined, the results suggested that post-surgical treatment could reduce the risk of the tumor recurring.
The analysis found a greater risk of recurrence in women in three circumstances: in women whose tumors were one centimeter compared to women with smaller tumors; in women who were 49 years or younger compared to older women; and in women whose tumors were confined to the breast ducts or lobules.
The authors say that more studies are needed. "Such studies will require large numbers of patients with prolonged follow-up," they write. "Until information from such trials becomes available, the findings from this study should be considered when decisions are made regarding the management of patients with tumors of one centimeter or less."
However, an editorial in the same issue questions whether this treatment option should even be considered until clinical trials verify the conclusion. Marc E. Lippman, M.D., and Daniel Hayes, M.D., of the Georgetown University Medical Center in Washington, D.C., suggest several reasons why combining results from several trials might lead to incorrect conclusions.
"This finding is a paradigm-shifting conclusion, especially in regard to chemotherapy," they write, "and we believe that this conclusion needs to be examined carefully."