2023-11-07 02:30:18
▶ Approximately 50% of breast cancer patients do not need chemotherapy.
Ms. Woo (55, female) felt a lump in her left breast three years ago and was diagnosed with ‘invasive breast cancer’ through mammography and biopsy at a local hospital. Afterwards, a 2 cm breast cancer mass was observed in a breast ultrasound and magnetic resonance imaging (MRI) examination at a university hospital. Ms. Woo successfully underwent breast cancer removal surgery, but was worried about the subsequent chemotherapy. This is because she heard that during chemotherapy, she suffered from severe pain, including hair loss and vomiting.
However, treatment for breast cancer patients has recently improved significantly to the extent that even breast cancer patients with lymph node metastasis do not need chemotherapy.
According to the ‘2020 National Cancer Registration Project Annual Report’, the total number of cancer cases in 2020 was 247,952, and the number of breast cancer patients was 24,923 (10.0%). The incidence of breast cancer ranks 5th among all cancers, but ranks 1st among female cancers.
However, the 5-year relative survival rate for breast cancer continued to increase, significantly improving from 79.2% in 1993 to 1995 to 93.8% in 2016 to 2020. The only cancer with a higher relative survival rate than breast cancer is thyroid cancer. The relative survival rate is the survival rate adjusted for death from causes other than cancer.
Although the breast cancer survival rate has improved significantly, patients still have concerns about chemotherapy and its side effects. Patients find it difficult to carry out their daily lives during the 3 to 6 months of chemotherapy. Even after chemotherapy, side effects such as cardiovascular disease and numbness in the hands and feet may occur due to toxicity.
However, breast cancer treatments have recently been greatly improved. Lee Jang-hee, a professor of surgery at Hallym University Dongtan Sacred Heart Hospital, said, “Recently, the number of cases of omitting chemotherapy for breast cancer patients who find that chemotherapy is unnecessary through genetic testing is increasing.”
Breast cancer is divided into four subtypes depending on the presence or absence of female hormone (estrogen, progesterone) receptors and the expression of HER2, an epidermal growth factor receptor. Among these, ‘female hormone receptor positive (+)/HER2 negative (-) breast cancer’ accounts for about 65%. In this case, breast cancer multiple gene expression tests such as OncoType DX, Oncopri, Geneswell BCT, and Mamma Print can be performed to confirm the benefit of anticancer treatment.
These tests calculate the patient’s recurrence score through multiple genetic analysis of the excised cancer tissue and then divide the patient into a low-risk group and a high-risk group.
If you are in a high-risk group, you can know in advance that there is a high risk of breast cancer metastasis, so you can increase the survival rate after breast cancer treatment through chemotherapy. According to a clinical trial that verified the effectiveness of anticancer treatment for high-risk groups, when treated with hormones alone, the 10-year survival rate without metastasis to other organs was 65.4%, but with anticancer treatment, the survival rate increased to 91.9%.
On the other hand, if you are in the low-risk group, the probability of cancer metastasizing to other organs is very low, so you do not need chemotherapy. In particular, according to the results of the ‘RxPONDER’ study published by the world’s largest breast cancer society in December 2020, it was confirmed that even breast cancer patients with lymph node metastasis can skip chemotherapy if their genetic test scores after menopause are below the standard.
Professor Janghee Lee said, “It is generally known that chemotherapy must be received to remove microscopic cancer after cancer surgery, but for hormone receptor positive (+)/HER2 negative (-) breast cancer, which is the most common type of breast cancer, anti-hormone treatment is a systemic treatment. “The global trend is to avoid anticancer treatment as much as possible because the response to anticancer treatment is relatively low.”
Accordingly, Professor Lee added, “Even patients whose breast cancer has spread to the lymph nodes may not receive chemotherapy if they are confirmed to be menopausal through a female hormone test, so about 50% of breast cancer patients can skip chemotherapy.”
However, even in low-risk breast cancer, there is a possibility of recurrence, so post-treatment management is important regardless of whether or not there is chemotherapy.
Daeik Kwon, medical reporter>
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