Breast Cancer ChoicesTM
li.
Scrutinizing the evidence for breast
cancer procedures and treatments
Treatment FAQ

Key question to
consider

Is information
patients receive
based on
customary,  standard of
care  "consensus" or
evidence based on
overall survival
statistics?


    I.

    My doctor gave me a pathology report listing a lot of things about the
    properties of my tumor.  
    What do they mean?

    If you choose conventional therapy, your oncologist will factor in
    all the elements of the pathology report and decide on a treatment
    course determined by the most recent treatment guidelines. Certain
    pathology findings are examined to determine whether or not
    chemotherapy will be recommended. However, many complementary
    practitioners consider much of the pathology information irrelevant for
    the purposes of making treatment decisions.

    This reasoning is based on the poor track record of chemotherapy's
    survival value for most breast cancers regardless of the findings in the
    pathology report.  

    Usually, complementary physicians only address the tumor’s hormone
    receptor status from the pathology report, and there is controversy
    between practitioners about whether hormone blocking for hormone-
    positive patients has any all-cause survival benefit. This controversy
    arises from the volume of studies showing breast cancer patients taking
    hormone replacement after their diagnosis survived as long as or longer
    than those who took no hormones.

    My doctor has recommended radiation to prevent recurrence
    after my lumpectomy. What can I read about this?

    Although it's been known for years that radiation does not offer any overall
    survival advantage after lumpectomy, an article published in the
    prestigious British medical journal The Lancet in 2000 shows that while it
    may reduce deaths from breast cancer by 13.2%,  death from all causes is
    21.2 % higher in radiation-treated women. Mostly, these women die from
    heart disease probably caused by radiating the chest.

    There is no question that radiation will “sterilize the area” around the
    tumor site and reduce local recurrence in the short term. But then
    radiation-induced breakdown of the coronary arteries begins to take its
    toll and overall survival statistics go south. Also, should you drop dead
    from a heart attack four years after radiation treatment, you are still
    counted as a breast cancer radiation success statistic since you did not
    die from breast cancer.

    Risks of Radiation May Outweigh Benefits in Some Breast Cancer
    Patients
    By Merritt McKinney    [Excerpt]                 

    WESTPORT, May 19 (Reuters Health) - A meta-analysis of randomized trials
    of radiotherapy in breast cancer patients shows that the treatment is
    associated with reduced local recurrence and breast cancer mortality, but
    also with increased mortality due to other causes.

    For older women as well as women of any age who have a low risk of
    recurrence, the risks of radiation may outweigh the benefits, researchers
    report in the May 20th issue of The Lancet.

    Dr. Rory Collins, of the Clinical Trial Service Unit at Radcliffe
    Infirmary, in Oxford, England, and other members of the Early Breast
    Cancer Trialists' Collaborative Group reviewed the 10-year and 20-year
    results of unconfounded, randomized radiotherapy trials that included
    19,582 women. All of the trials began before 1990.

    Overall, radiation prevented about two thirds of local recurrence,
    regardless of patient characteristics or radiation type, Dr. Collins told
    Reuters Health. According to Dr. Collins, radiation therapy appears to
    translate into "moderate improvement in avoidance of breast cancer
    deaths." He noted that the benefits of radiation tended to be greater in
    node-positive women.

    When the results of all studies were combined, women who received
    radiation did not have lower breast cancer mortality in the first 2 years,
    but after that, the annual breast cancer mortality was about 13% lower than
    that of women who did not undergo radiation, according to the report.

    Despite the reduced breast cancer mortality associated with radiotherapy,
    however, overall mortality was actually higher in radiation-treated women.
    Beginning 2 years after randomization, the annual non-breast cancer
    mortality rate was 21.2% higher in women treated with radiation.

    This increased mortality "appeared chiefly to involve an excess of vascular
    deaths, perhaps due to inadvertent irradiation of the coronary, carotid or
    other major arteries," the authors write. [end excerpt]

    The original study referenced above:
    Lancet 2000;355:1739-1740,1757-1770. [See article abstract in Medical
    Studies]

    My doctor has recommended chemotherapy treatment because
    I "will gain a 30% benefit" from undergoing this treatment.  
    What does this mean?

  • There are certain words used in the cancer field that can be
    misleading. Two of them are “response” and “benefit.”  A tumor may
    shrink with chemotherapy or lower your tumor markers but not
    prolong your life. When reading any study keep in mind that the
    phrase, "disease-free survival" is only the amount of time until
    recurrence.

  • Remember to consider only "overall survival." It won't do any good
    to get a 30% cancer response rate but no improved overall survival
    because of a possible chemotherapy-related side effect such as
    leukemia or heart disease. Check out all recommended
    chemotherapy drugs on rxlist.com.

  • Ask your doctor for the “overall survival” statistics for the
    recommended therapy.  Ask to see the published articles, the actual
    studies which spell the overall survival numbers out.  Put them in
    your Patient Portfolio to read carefully later.


  • If the doctor says you won’t understand them, you can say, “That's
    okay. I have smart friends." If the doctor brings in a colleague and
    they both say they would recommend the therapy for their own
    daughters, you can thank them for their frankness, but get the
    studies in your hands before leaving.

The take home question is: when your survival and quality of life are
at stake do you really want to take somebody's word for it about
what's good for you? Or do you want to see documented published
evidence about survival advantage?

    Chemotherapy research is done drug by drug and often difficult to
    evaluate. Most doctors try a “cocktail,” a combination of toxic agents
    called polychemotherapy to achieve “response.” But each
    recommendation you receive must be evaluated.  Consider the following
    study from the prestigious medical journal,The Lancet ,[highlighted
    emphasis added for clarity] which factors quality of life into its calculations.

    Lancet 2001 Jul 28;358(9278):277-286        
    Polychemotherapy for early breast cancer: an overview of the
    randomised clinical trials with quality-adjusted survival analysis.
    Cole BF, Gelber RD, Gelber S, Coates AS, Goldhirsch A.
    Dartmouth College Medical School, Lebanon, NH, USA.

    BACKGROUND: Overview analysis involving 18000 women with breast
    cancer in 47 randomised trials showed that prolonged chemotherapy
    significantly reduces the risk of relapse and death compared with no
    chemotherapy. Here we express the size of the benefit in terms of
    quality-adjusted survival time gained. METHODS: We used the Q-
    TWiST method (Quality-adjusted Time Without Symptoms of disease
    and Toxicity of treatment) to provide treatment comparisons within 10
    years' follow-up, incorporating differences in quality of life associated
    with times patients spend with chemotherapy toxic effects, after
    relapse, and without symptoms of relapse or toxicity.

    FINDINGS: Within 10 years' follow-up the benefit of increased
    relapse-free and overall survival for younger women (<50 years old)
    who received polychemotherapy balanced the burdens in terms of
    acute toxic side-effects, especially among women enrolled in trials
    that did not include tamoxifen. Overall, chemotherapy-treated
    younger women gained an average of 10.3 months of relapse-free
    survival and 5.4 months of overall survival within 10 years (p<0.0001
    for both) compared with the no-chemotherapy group.

    Polychemotherapy provided more quality-adjusted time than control
    across nearly all values of utility weights for time spent undergoing
    chemotherapy and time after relapse. The range of benefit was from -
    0.6 to 10.3 months. For older women (50-69 years) overall,
    polychemotherapy also provided significant benefit compared with no
    chemotherapy but, compared with younger women, the size of benefit
    was less and the range of utility-weight values favouring
    polychemotherapy was smaller.

    Average gains for older women treated with polychemotherapy
    (with or without tamoxifen) were 6.8 months of relapse-free
    survival (p<0.0001) and 2.9 months of overall survival (p=0.0001)
    within 10 years. The range of quality-adjusted benefit was -3.1 to 6.8
    months. For older women with oestrogen-receptor-poor tumours who
    did not receive tamoxifen (9% of the total), the benefit of
    polychemotherapy was significant and similar to that observed for
    younger women. INTERPRETATION: The benefits of adjuvant
    chemotherapy within 10 years outweigh the burdens especially for
    younger women (<50 years old) and among older women (50-69 years)
    to a lesser degree. Additional studies to compare the quality-adjusted
    survival of chemotherapy plus endocrine therapy versus endocrine
    therapy alone are required for younger patients with tumours that
    express steroid-hormone receptors.
    ----------------------------------------------

    How can I find out about the risks of doing chemotherapy treatment?

    The risks of chemotherapy are listed in the consent form that you sign
    prior to starting treatment. There may be some variation with each drug
    but please see a generic consent form at this link Generic Chemotherapy
    Consent Form.

    I have hormone receptor-positive cancer. What about Tamoxifen?

    Tamoxifen has been misrepresented as a drug which will significantly
    increase survival in hormone receptor positive patients. One breast
    cancer activist claims it will reduce recurrence by 50%. This figure does
    not reflect the actual survival statistics. Tamoxifen's manufacturer states
    the difference between node-negative Tamoxifen takers and non-takers is
    small. If you do the math, you will see the survival advantage for node
    negative patients taking Tamoxifen is 3.5%.  

    That means there is a 96.5% chance that taking Tamoxifen will not increase
    lifespan but will still expose the patient to risk of endometrial cancer,
    depression, blood clots, vaginal atrophy, hot flashes and other side
    effects.

    You may want to research hormone options and tell your doctor about your
    findings. Be aware Tamoxifen clearly has a documented downside. You
    may want to Google Sherrill Sellman’s article, “The Dark Side of Tamoxifen”

    Can I design my own alternative protocol or should I find a
    practitioner to guide me?

    In the first couple of years, most alternative therapy patients function best
    under the guidance of an experienced practitioner. Others feel confident
    to research and design their own protocols.

    Has any one protocol been proven to cure breast cancer?

    No. What works for one person may not work for another, whether it is
    conventional or non-standard.

    Somebody suggested the AMAS test to monitor the status of my
    cancer.  

    Speaking from 13 years on the Email Group, we’ve seen a huge  number
    of false negatives with the AMAS test. That is, the test missed a cancer
    determination when there was active, disease verifiable by biopsy or
    scans.

    I’ve been taking HRT. Should I stop?

    The majority of  studies show that taking HRT after breast cancer
    diagnosis, paradoxically, does not effect survival. Click on HRT AFTER
    BREAST CANCER for documentation on this and review the surprising
    information with your doctor. That being said, those taking Prempro before
    diagnosis appear to be at increased risk for lobular cancer. (JAMA 2003;
    289:1421-1424.)

    The alternative medicine community does not look kindly on synthetic
    hormones and prefers bioidentical hormones when hormones are
    prescribed. Taking hormones of any kind remains controversial, so review
    the studies and make this choice along with your doctor.

    What about Iodine, DIM, I3C, progesterone or calcium glucarate
    instead of Tamoxifen for hormone modulation?

    There are many strategies reputed to reduce your risk of recurrence. We
    have been researching progesterone for 15 years. Check our
    progesterone research page. Read up and consult a practitioner
    experienced with these supplements. Also go to Healing Strategies.

    My family is pressuring me to take chemo and radiation therapy.
    How have other patients handled this?

    Join the an online breast cancer group for those using non-standard or
    integrative therapies and ask.

    Update:  What is the rate of side effects for chemo?

    Of 4075 breast cancer patients who had chemotherapy, roughly one in six
    of these patients showed up in the emergency room or were hospitalized
    due to side effects, such as low blood pressure, dehydration, or nausea.
    (See Hassett M et al., Frequency and Cost of Chemotherapy-Related
    Serious and Adverse Effects in a Population Sample of Women with Breast
    Cancer, JNCI 2006.)

    If I have chemo, will I have brain fog, called "chemo-brain"?

    Update: 21 patients who had chemotherapy within the past 5-10 years were
    asked to perform a short-term memory task.  PET scans revealed a link
    between chemo-brain symptoms and lower metabolism in the frontal
    cortex. The lower the metabolism in the frontal cortex and the cerebellum,
    the more difficult it is to perform a short-term memory exercise.  (See
    Silverman D et al., Altered Frontocortical, Cerebellar and Basal Cranial
    Activity in Adjuvant-Treated Breast Cancer Survivors 5-10 Years After
    Chemotherapy, Breast Cancer Res Treat 2006.)

    Specifically, what is the neurological effect of taking three
    mainstream chemo drugs?

    Update: Taking carmustine, cisplatin, and cytosine arabinoside have been
    found to be more toxic for the progenitor cells of the central nervous
    system and cells that help myelinate the nervous system than they are for
    multiple cancer cells lines.
    (See Dietrich J, CNS Progenitor Cells and Oligodendrocytes are Targets of
    Chemotherapeutic Agents In Vitro and In Vivo, Journal of Biology 2006.)

    I’ve just finished chemotherapy and my tumor markers are back to
    normal. Is there anything more I can do?

    Congratulations on getting through your treatment. No matter what
    treatment we started out with, we are all trying to prevent recurrence. You
    may want to join an online group to investigate how patients try to boost
    their immunity by cleaning up toxins from their households as well as their
    bodies. Chlorine, fluoride, benzenes and a host of other chemicals are all
    around us. Part of our clean up strategy is to reduce the toxic load on our
    immune systems.


Please report dead
links or suggestions
about this page.

Thanks in advance.
Negative nodes?
3.5% difference
between Tamoxifen
takers and non takers

Specific antibiotics
sometimes used in
chemotherapy regimens.









On July 8, 2008, the FDA
ordered a black box
warning on certain
antibiotic medications
containing
fluoroquinolone, which
has been linked to tendon
ruptures,  tendinitis and
toxicity. Included were the
popular drugs Cipro,
Levaquin, Avelox, Noroxin
and Floxin.

Many legal actions are
pending regarding these
drugs.

Keep a Patient Notebook











Take notes at every  
practitioner visit.

Have a friend or family
member there to take notes
separately since patients
may be concentrating on
the interview and miss
details.

NOTE: Radiation Therapy
reduces by 10% the
recurrence within the
breast for five years--
NOT the 40% "relative
risk" figure that is
usually given.

Radiation Therapy
provides no survival
value.


New England Journal of
Medicine on Radiation
Survival Statistics

The National Adjuvant
Surgical Breast and
Bowel Project Report:

After 20 years of follow up,
we found no significant
difference in overall
survival in women wo
underwent mastectomy or
lumpectomy with or
without post operative
radiation.

What about radiation after
mastectomy?

No advantage after 25 year
follow up.
Read the New England
Journal of Medicine.


.

The purpose of
patient education is
to equip the patient to
make informed
decisions for her own
treatment-- NOT to
convince her doctor
of the validity of her
decisions. --MH

What are the hidden
statistics in treatment
recommendations?
How to ask your doctor
for "overall survival"
information.












Dr. Eric Winer from Dana
Farber Cancer Institute
VIDEO From 2010:
Aromatase Inhibitors as
adjuvant therapy offer no
survival value.

Video has been removed
.

Recent /ongoing
Tamoxifen Studies show
some  reduction in
recurrence but no  
improvement in overall
(all-cause) survival

    These statements have not been evaluated by the U.S. Food & Drug Administration.  The
    information discussed is not intended to diagnose, treat, cure, or prevent any disease.

    This website is intended as information only. The editors of this site are not medically-trained.
    Please consult your licensed health care practitioner before implementing any health strategy.

    The information provided on this site is designed to support, not replace, the relationship that
    exists between a patient/site visitor and his/her existing physician. This site accepts no
    advertising. The contents of this site are copyrighted 2004-2014 by Breast Cancer Choices,
    Inc., a 501 (c) (3) nonprofit organization run entirely by unpaid volunteers.
    Contact us with comments or for reprint permission at admin@breastcancerchoices.org


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links or suggestions
Thanks in advance.

Anti anemia drugs
reported to decrease
survival of cancer
patients








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