Size of Tumor May Affect Treatment

Breast cancer patients with large tumors or cancer that has spread typically undergo chemotherapy or take the drug tamoxifen after surgery to prevent recurrence of the disease. After all, studies show that such treatment can improve the chances of a complete cure.

But for women with small tumors--less than 1 centimeter--decisions about post-surgical treatment may be more complicated.

A new study by Los Angeles researchers, one of the largest to examine long-term quality-of-life issues for breast cancer survivors, found that such post-surgical treatment can later impair women’s ability to function. Because women with small tumors have a much higher survival rate, the risk of impairment could be one they’re not willing to take.

The study, published last week in the Journal of the National Cancer Institute, compared 763 healthy breast cancer survivors five to 10 years after treatment. Women who had opted only for surgery were compared with women who chose surgery plus treatment with chemotherapy or tamoxifen. Tamoxifen, a drug that blocks the effect of the hormone estrogen, has been shown to lower the risk of cancer recurrence.

The analysis showed that women with adjuvant treatment tended to report more problems with physical functioning, such as sports participation and household chores.

“Chemotherapy and tamoxifen are very important,” says Dr. Patricia Ganz, lead author of the study and director of the Division of Cancer Prevention and Control Research at the Jonsson Cancer Center. “They have saved lives and reduced the death rate from breast cancer substantially. But for women with tiny tumors, the likely benefits from adding chemotherapy are quite small. Knowing that there are some subtle costs may help women decide what to do about adjuvant therapy. It may help doctors frame the issue better.”

While the study shows there are long-term costs to undergoing additional treatment, there is no clear-cut answer as to whether women with small tumors should opt for chemotherapy or long-term use of tamoxifen, Ganz says. The issue has been hotly debated among doctors in recent years.

“Ultimately, it’s the woman’s choice,” she says.

The study comes at an interesting time, says Barbara Brenner, executive director of Breast Cancer Action, a consumer organization based in San Francisco. “We’re beginning to see what chemotherapy means for women’s lives at the very time when the push in the medical community is to give more women with smaller breast tumors chemotherapy,” she says.

The study also showed that younger women tended to report more long-term quality-of-life issues than women who were diagnosed at older ages. That finding is in keeping with other studies that show younger women have more difficulty coping with breast cancer treatment, Ganz says.

Overall, however, all of the women in the study reported a high quality of life and no deterioration of emotional or social functioning five to 10 years after diagnosis. The same group of women studied one to five years after treatment had complained of various quality-of-life issues.

“Some of the symptoms they had while on tamoxifen, such as hot flashes, had diminished,” Ganz says. “That is the good-news piece of this.”