Doctors Debate Value of Chemotherapy

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The breast cancer trifecta was once indisputable: Surgery, radiation, chemotherapy. This combination has led to great numbers of cancer survivors, but is it all necessary?

According to a 2015 paper published in the New England Journal of Medicine, a study of more than 10,000 women found very low rates of cancer recurrence in women who had early stage breast cancer with no lymph node involvement and who were treated with hormonal therapy alone.

This study and others are leading oncologists to ask if, in early stage treatment, chemotherapy is overprescribed.

Cancer mortality rates have been much improved since the 1980s, with a nearly 40 percent decrease in deaths, and credit for that win goes generally to chemotherapy. But chemo is a dramatic chemical attack that comes with its own problems. With new advances in genomic testing and tumor biology, some oncologists are asking if it is always necessary.

In fact, use of chemotherapy to treat early breast cancer has been declining. In a study of about 3,000 early-stage tumor patients, use of chemotherapy declined to 21 percent from 34 percent.

But cancer experts warn that withholding chemo is justified in only a fraction of cases. Focusing on the bad side effects of chemotherapy misses the point, some doctors say, stating it has saved the lives of hundreds of thousands of people.

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