In today’s breast cancer treatment, less sometimes means better

October 16, 2006
The greatest advances in breast cancer treatment today may have more to do with the treatment a patient doesn’t receive.

Cyrus Kotwall, MD, Medical Director of New Hanover Regional Medical Center’s Zimmer Cancer Center, said the medical profession is learning more about when it can treat patients without subjecting them to often unnecessary chemotherapy and radiation – and their side effects.

“In the old days, we used to throw the book at everybody,” Dr. Kotwall said. “We’re getting smarter in identifying who we should give treatment to and who we shouldn’t.”

Physicians are now able to send samples of tumors for genetic study. Based on the results, the patients are given a “recurrence score” to determine if they are “high-risk” and will benefit from chemo, or “low-risk,” and will benefit from oral endocrine manipulating drugs only, with much fewer side-effects.

“We think we can identify a favorable group of patients that need not require chemotherapy,” Dr. Kotwall said.

The key for women remains regular screening and early detection, he said. If tumors are diagnosed early enough, a genetic test can determine how, or if, the cancer will spread, helping shape future treatment – or, more importantly, whether some treatment is even necessary.

The therapies themselves are improving as well, Dr. Kotwall said. Herceptin, a drug he calls the “biggest breakthrough in treatment in five years” can confront an “oncogene” and halt its ability to divide and spread throughout the body.

The Cancer Center has also upgraded its radiation therapy technology, installing “Intensity Modulated Radiation Therapy” which better focuses on treating the cancerous cells while minimizing tissue damage to surrounding areas of the body.

The Cancer Center is designated as a Teaching Hospital Cancer Program, by the National Commission on Cancer. Dr. Kotwall said the center is participating in 14 breast cancer clinical trials, three of them actively seeking patients.

One trial beginning in January 2007 will build on the highly successful “STAR” study, which showed that the drugs tamoxifen and raloxifene, given as a preventive measure, can reduce the incidence of breast cancer in women who are at high risk for the disease. The January study will see if aromatase inhibitors are better than raloxifene.

Dr. Kotwall said education, prevention and collaboration continue to be keys to combating the disease. The Cancer Center is taking part in a five-year National Cancer Institute program to encourage minority women to seek treatment earlier, and its physicians meet weekly with community physicians as part of the Tumor Board, in which difficult cases in all cancer sites are presented so that the region’s leading experts can come up with the best protocols.

Mammograms are recommended on an annual basis for any woman older than 40. If a grandmother, mother, sister or daughter has been diagnosed, a woman should receive a mammogram at an age 10 years younger than their relative’s age when diagnosed.

Dr. Kotwall said early detection and regular screening, combined with research and improved technology, will continue to revolutionize how breast cancer patients will receive treatment.

“Everyone has their own individual genetic signature,” he said. “We’ll have much more individualized treatment in five to 10 years. The way we treat malignancy will be very different in the near future.”

For an appointment at the Zimmer Cancer Center, please call 342-3000