'I would have been very thankful' to skip chemo, breast cancer survivor says after new study's findings
New U.S. study says many women with early-stage breast cancer could skip chemo
A breast cancer survivor says she has mixed feelings at the news that the chemotherapy she underwent may not have been necessary.
"It's not a fun experience," said Dory Kashin, who was diagnosed with breast cancer at 29.
"It's about four months of your life … and it's really bad psychologically. Going through those chemotherapy treatments you feel very isolated," she told The Current's Anna Maria Tremonti.
"If there was an opportunity for me not to go through it, I think at the time I would have been very thankful."
A new U.S. study, which followed 10,000 patients over a nine-year period, suggests that chemotherapy is of no benefit to thousands of women battling breast cancer. The study was published in the New England Journal of Medicine.
Dr. Kathy Pritchard, an oncologist and the Canadian chair of the trial, explained that the findings are only relevant to a specific type of patient: one who has early-stage disease that had not spread to the lymph nodes, is hormone-positive (meaning its growth is fuelled by estrogen or progesterone) and is not the type that can be targeted by the drug Herceptin. The study focused on women with an intermediate risk of cancer recurring.
"Overall, they did just as well with endocrine therapy, hormonal therapy only, as they did when we added chemotherapy," she told Tremonti.
"Women over 50 [or] women who are postmenopausal are probably not benefiting at all from this chemotherapy."
She estimates that in Canada, 30,000 women a year may not need to undergo chemotherapy.
Kashin's treatment progressed quickly after her diagnosis.
Within two months she had undergone surgery and begun chemotherapy, and was facing decisions that led her to have a double mastectomy, and a conversation with her boyfriend about whether they wanted to one day have kids.
Two years later and in good health. She's happy she did everything she could to beat the disease, and reduce the risk of it returning.
"If, God forbid, something happens I know I did everything I could," she told Tremonti. "I won't be regretting like: 'Oh I should have done chemotherapy, I made the wrong decision five years ago, 10 years ago.'"
The risk of over-treatment
The desire to embrace any treatment available is a common one, according to Dr. Steven Katz, but can sometimes lead to harmful over-treatment.
"Patients are not trained to be patients," he told Tremonti.
Anticipating the regret they may have in the future ... fuels the desire to take everything they can possibly take now, to get home to their family.- Dr. Steven Katz
Katz is a professor of medicine and health management and policy at the University of Michigan. He studies how treatment decisions are made when women are newly diagnosed with cancer, which can be influenced by what he calls "anticipated regret."
"They're anticipating the regret they may have in the future," he said, "and that fuels the desire to take everything they can possibly take now, to get home to their family members and to their work, as safely and as quickly as they can."
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It can leave patients vulnerable to receiving "surgery more extensive than they need, radiation more extensive than they need, and chemotherapy that they may not have needed."
"One of the great results of this study is that it adds to the accuracy of the evaluative testing that doctors have to say: 'You don't need the chemotherapy, you can do fine with other kinds of therapies here — less toxic, and your survivorship and quality of life will even be better."
Listen to the full conversation near the top of this page.
With files from Associated Press. This segment was produced by The Current's Julie Chrysler, Jessica Linzey and Geoff Turner