Dr. Sunil Gandhi, Cancer & Blood Disease, 7/8/14

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Blood test to detect breast cancer

By Dr. Sunil Gandhi

Almost every woman would agree to a blood test to know her odds of recurrence of breast cancer. A new German study published in the May 15 issue of the Journal of National Cancer Institute (JNCI) suggests that. 

Breast cancer strikes more than 200,000 women every year in the U.S.A. Due to widespread use of mammography, most women get diagnosed at an early stage. The standard treatment is surgery. Most patients need systemic therapy, either hormone or chemotherapy, after surgery to reduce the odds of recurrence of the cancer.

Researchers analyzed circulating tumor cells (CTCs) in peripheral blood from patients from the SUCCESS trial. Samples were taken from 2,026 patients after primary surgery and before systemic treatment and in 1,492 patients after chemotherapy. The patients were followed for three years.

This test detects the presence of cancer cells in blood. It is believed that at the time of diagnosis, some cancer cells have already left the breast and they may be circulating in the blood and may lodge in distant organs, eventually causing metastatic stage IV and incurable cancer.

The patients were classified into four groups: positive for CTCs both before and after treatment, negative for CTCs both before and after, positive for CTCs before but negative after, and negative CTCs before but positive after treatment. 

Those with positive CTCs both before and after treatment had the worst disease-free survival compared to the other three groups. Patients with five or more CTCs in 30 ml of blood were at higher risk of recurrent disease.

This test is widely available in the U.S.A. — unfortunately it costs approximately $700 or so and most insurance policies won’t cover for this indication. This is because the use is not of proven value yet.

It’s hoped the CTC blood test will function as a real-time biopsy, providing an early alert system to identify patients who aren’t responding to treatment, said lead researcher Dr. Brigitte Rack, senior physician in the department of gynecology and obstetrics at Ludwig-Maximilians University in Munich, Germany.

While the study is promising, it’s too soon to know what to do when a patient has a positive CTC, said Dr. Arnold Schwartz, author of an 

editorial accompanying the study. “Should we change chemo, or give more chemo? Clearly we can tell the patient that this is something we need to follow. But the data is not definitive yet,” he said.

I think the study is very intriguing but not definitive yet. This definitely will be followed by more study. It seems very promising to me.

Dr. Sunil Gandhi is a hematologist and oncologist. He is the 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.