Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, February 18, 1992 TAG: 9202180160
SECTION: EXTRA PAGE: E-6 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
HOW TO CHOOSE THE RIGHT TREATMENT
The following summary of the major findings as they relate to different women should help patients and doctors choose the most appropriate regimen for treating breast cancer:
In women over 50, most of whom were past menopause, treatment for two or more years with tamoxifen alone yielded better results than six months of multidrug chemotherapy. Combining the two therapies gave the best results.
Also among women over 50, tamoxifen was more effective than chemotherapy in those whose tumors tested positive for estrogen receptors. In those who tested negative for estrogen receptors, tamoxifen was as effective as the cell-killing drugs in staving off a recurrence.
In women over 70, tamoxifen alone, a treatment that is associated with few side effects, produced results as good as those with chemotherapy and could be an acceptable alternative to the more toxic drugs for older women as well as for women with other medical conditions that would make chemotherapy especially hard to take.
In women under 50, most of whom had not yet begun menopause, stopping ovarian function produced as good results as multidrug chemotherapy, with just a little additional improvement by combining the two treatment approaches.
The studies suggested that much of the benefit seen with chemotherapy may result from the fact that in most premenopausal women with breast cancer, chemotherapeutic drugs stop ovarian function and induce early menopause.
Stopping ovarian function through surgery or radiation or hormone treatments is considered safer and easier to tolerate than chemotherapy and thus may be an alternative treatment for many premenopausal women, Peto said.
Still unknown is whether it would be safe to give such women hormone replacements to relieve menopausal symptoms, reduce bone loss and lower the risk of heart attack. Nor is it known if younger women would experience a further benefit from tamoxifen once they have undergone menopause. The findings strongly suggest that they would.
Cancer specialists are not sure how long after treatment of the original cancer a woman could still start adjuvant therapy and expect to benefit.
Most experts believe that chemotherapy should be begun within three to five months, and that after six months to a year, there is no point in starting the treatments. But they also believe tamoxifen therapy could be started at any time and still be helpful. - The New York Times