Adjuvant Chemo Benefits Even Small Breast Cancers

OB/GYN News,  March 15, 2000  by Bruce Jancin

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SAN ANTONIO -- Long-term outcome of even the smallest breast cancers is enhanced by postoperative chemotherapy, Dr. Elizabeth Tan-Chiu reported at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

And in patients with small estrogen receptor-positive tumors, outcomes following surgery are best when chemotherapy and tamoxifen are added to the treatment regimen, said Dr. Tan-Chiu of the University of Pittsburgh.

There aren't much data on the worth of adjuvant therapy following surgery in women with breast cancer lesions of 1 cm or smaller. To clarify the matter, Dr. Tau-Chiu reanalyzed from five earlier National Surgical Adjuvant Breast and Bowel Project (NSABP) studies involving 1,260 women with breast tumors of 1 cm or less.

In patients with estrogen receptor-negative tumors, relapse-free survival at 8 years follow-up was 79% with surgery alone and 94% with surgery plus chemotherapy. Event-free survival--that is, freedom from tumor recurrence in the same or opposite breast, a second primary cancer, or noncancer death--was 70% with surgery alone, compared with 81% with adjuvant chemotherapy.

In women with estrogen receptor-positive tumors, 8-year recurrence-free survival was 86% with surgery 92% with surgery plus 5 years of tamoxifen, and 94% with surgery tamoxifen, and chemotherapy Event-free survival was 74% with surgery 82% with the addition of tamoxifen, and 88% with surgery tamoxifen, and chemotherapy.

There was a nonsignificant trend toward improved overall survival in patients with estrogen receptor-positive tumors who got adjuvant chemotherapy plus tamoxifen. She predicted that this trend will achieve statistical significance with longer follow-up of 10-12 years.

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