A new approach to breast cancer treatment.

A NEW APPROACH TO BREAST CANCER TREATMENT 

There is perhaps no more distressing diagnosis to the female patient than breast cancer. Not only does it convey the possibility of premature death, but also of disfigurement in the treatment process. Lumpectomy has been a welcome alternative to mastectomy because it involves removal of only the tumor itself--but only for tumors an inch or less in diameter.

A report in the July Cancer, the journal published by the American Cancer Society, now gives new hope to breast cancer patients. A 10-year study conducted by French researchers shows promising results for breast cancer treated without surgery. Two hundred and fifty patients in various stages of breast cancer development were subjected to intensive chemotherapy and radiation as soon as they were diagnosed. Five years after therapy had begun, all patients whose disease was discovered in the early stage, with only small local tumors, had survived. Among women with larger, but still localized, tumors--or those whose disease had spread only to adjacent lymph nodes--82 percent were expected to be disease-free after five years. Patients with large tumors that had spread to more distant lymph nodes, on the other hand, showed only a 52 percent survival rate.

Because the French study did not also include a comparable group of patients receiving more traditional therapy, no one knows whether the nonsurgical approach is superior in terms of life expectancy. Nevertheless, the fact that breast cancer can be successfully treated without surgery is an encouraging development. Several U.S. centers are now collaborating on studies in which half of the subjects will receive the standard surgical treatment followed by chemotherapy and radiation, while the other half will be treated without surgery. Patients in the latter group will be offered surgery if nonsurgical methods prove inadequate.

The problem with these and similar approaches to other forms of cancer is that research teams must ask patients to volunteer for therapies that have not yet stood the test of time. However, one advantage of this new approach to breast cancer is that women whose lesions are too large for lumpectomy (greater than one inch in diameter) may find that chematherapy and radiation will reduce their tumors sufficiently enough to allow surgical removal of the tumor alone, without removing the entire breast.