Dr. Sunil Gandhi, Cancer & Blood Disease, 01/22/13

I recently saw Mrs. Smith. She is 70 years old. Almost 12 years ago, she was diagnosed with breast cancer in her left breast.

She was treated with a lumpectomy (the removal of cancerous breast tissue but not the whole breast). She also had radiation therapy and then chemotherapy followed by hormone therapy with tamoxifen for five years.

She was going for regular follow-up and mammogram. Now, she has new cancer in her remaining left breast. She was referred to me and so I did PET/CT scan and there is no radiological evidence of distant spread of her cancer to organs like the liver, lung or bones.

She was referred to her surgeon, who removed the remaining left breast. She has almost a half an inch cancer in her breast, which fortunately has not spread to any lymph nodes. Recently, the first study of its kind was presented at the 35th annual San Antonio Breast Cancer Symposium (SABCS).

The study was comprised of 162 patients who had local breast cancer recurrence many years after original diagnosis, just like in my patients. They randomized patients to either give chemotherapy or not. The treatment was given for three to six months.

The choice of chemo­therapy depended on what the patient received at the time of their original diagnosis and it was selected by the patient’s oncologist. My patient received Adriamycin chemotherapy 12 years ago, and so I would not like to give her the same chemotherapy again due to the risk of side effects on her heart.

The study showed significant benefit for patients who received chemotherapy. There was an absolute difference of 12 percent in the five-year disease-free survival rate between the chemotherapy group and the no-chemotherapy group (69 percent vs. 57 percent). Disease-free survival means cancer did not come back at all.

There was also an absolute difference of 12 percent in the five-year overall survival rate between the chemotherapy group and the no-chemotherapy group (88 percent vs. 76 percent). Overall survival means the patient is alive irrespective of cancer recurrence. This is always higher than disease-free survival because even if cancer recurs, many women can live with treatment for many more years.

This is very significant benefit. Patients with an isolated local and/or regional recurrence of breast cancer have a poor prognosis and are at high risk for developing metastases in other areas of the body.

Once cancer progresses to distant organs like the lung, liver, bone, etc., it becomes incurable. At that time, treatment is only palliative. 

Our goal in my patient is curative. I have recommended her chemotherapy and she is going to start it very soon. I am really optimistic that my patient will be cured from her cancer.

Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.