Dr. Seema Doshi was taken aback and frightened when she discovered a tumor in her breast that was later determined to be malignant.
“It really shook my life,” Dr. Doshi, a dermatologist in private practice in the Boston suburb of Franklin who was 46 at the time of her diagnosis, told the Boston Globe. “I thought to myself, ‘That’s it.’ ‘I’m going to have to go through chemotherapy.'”
Dr. Doshi was the beneficiary of a quiet revolution in breast cancer treatment, a gradual but steady reduction in the number of women who are advised to undergo chemotherapy for the disease. Chemotherapy has been used to treat breast cancer and other malignancies for decades, according to Dr. Gabriel Hortobagyi, a breast cancer expert at MD Anderson Cancer Center in Houston. “Chemotherapy has been the norm, the orthodoxy,” he said. However, evidence from a number of sources provides some support of what many oncologists have seen anecdotally – that the technique is becoming less popular with cancer patients in general.
Chemotherapy may now be determined whether or not it is helpful based on genetic testing. The use of an ever-expanding variety of medicines, such as oestrogen blockers and therapies that kill malignancies by targeting particular proteins on the surface of tumours, provides improved choices for many people. In addition, oncologists are becoming more ready to reduce the number of useless therapies they provide.
As a consequence, thousands of people each year are spared the dreaded chemotherapy treatment, which is associated with hair loss, nausea, tiredness, and the possibility for irreversible damage to the heart and nerves in the hands and feet, among other side effects.
Other malignancies are also seeing a reduction in chemotherapy treatment, including lung cancer, which is the most frequent cause of cancer mortality in the United States, killing more than 69,000 Americans each year and is the leading cause of cancer death worldwide. (Breast cancer is the second leading cause of death, with 43,000 deaths.)
Despite this, the chance to avoid chemotherapy is not equally distributed, and it is often depending on where and by whom the individual is being treated.
However, for certain individuals who have been fortunate enough to get treatment at specific cancer treatment facilities, the course of treatment has been altered. Even when chemotherapy is appropriate, physicians are increasingly prescribing fewer medicines for a shorter period of time.
The National Cancer Institute’s breast cancer treatment recommendations, published 30 years ago, were severe, recommending chemotherapy for about 95 percent of patients with advanced breast cancer.
When Herceptin, the first targeted medication for breast cancer, was authorised as a first treatment for about 30% of patients with a specific protein on their tumour surface 15 years ago, the world started to change. It was administered in conjunction with chemotherapy and was shown to decrease the risk of recurrence by half and the risk of dying from breast cancer by a third, “virtually independent of the amount and kind of chemotherapy administered,” according to Dr. Hortobagyi.
The availability of more affordable and quicker genetic sequencing has played a significant role in this transformation. Doctors were able to examine tumours to determine whether they would react to specific medicines because of the advancement in technology. Individuals who would benefit from treatment were correctly identified using genetic testing that examined arrays of proteins on cancer cells.