While the NHS is to now provide women with more detailed advice about the disadvantages of breast cancer screening – that it can lead to over-diagnosis and treatment of tumours that would never have been a problem – there is welcome news for women faced with a diagnosis of breast cancer and who have to make a decision regarding chemotherapy. The National Institute for Clinical Excellence has approved a new breast cancer test that could end the need for unnecessary chemotherapy following surgery.
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The new test
Oncotype DX, as the new test is called, works by identifying the activity of specific genes within tumour cells that have been removed. The activity of these genes indicates the likely rate of growth and spread of a tumour, which is a predictor of tumour recurrence. Results of the test would be used in conjunction with other factors known to influence the chance of a tumour returning such as its size, grade and a woman’s family history of the disease. NICE is recommending the test be used for a particular form of early breast cancer that affects women and is linked to the hormones oestrogen and human epidermal growth factor.
Informing decision for chemotherapy
Providing women in this group and their doctors with additional information about the likelihood of whether their cancer will return helps them to gain a better understanding of whether they are likely to benefit from chemotherapy, which can cause side-effects such as tiredness, sickness and hair loss. This is particularly helpful for these women, who are considered to be at intermediate risk of recurrence, as it can otherwise be difficult to weigh up the benefits of this treatment against the adverse effects. However, until now NICE has advised that both those at intermediate and high risk be treated with chemotherapy as a precaution, as it can be difficult to judge which women at intermediate actually require it. NICE is keen to stress though that the test cannot provide exact certainty as to whether breast cancer will recur and cannot indicate whether a woman will respond favourably to chemotherapy.
Progress in Herceptin delivery
Another piece of good news for women undergoing chemotherapy and who require Herceptin to accompany this is that the drug, which is currently administered intravenously via a drip, will now be able to receive it as an injection. This offers a much quicker and more comfortable means of delivery, reducing the time patients need to remain in hospital to receive Herceptin. This new treatment will also be more time effective for pharmacy staff and nurses, making them more available for other duties when services are already stretched. Cost savings are an additional benefit, as the new formulation for Herceptin is given as a fixed dose rather than being dependent on someone’s weight, reducing wastage.
By Amy Millband