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An American breast cancer clinical trial (TAILORx) has recently been published which reports: “70% of women do not need chemotherapy after surgery for breast cancer”.
Whilst it is true that the trial did provide important information about some patients having very little benefit from chemotherapy in addition to taking an anti-hormone tablet, some of the reporting around this trial is misleading.
Large scale studies over the past 40 years have shown that chemotherapy after surgery can reduce breast cancer relapse, to a very large degree in some patients; whilst other patients may only get very little benefit. A lot of research has been done to try and identify those patients in the “grey-zone” where the benefit from chemotherapy may be very small. The TAILORx trial looked at whether a specific test called OncotypeDX (which is performed on the cancer specimen), could show which patients fall into the “grey-zone”. Thus, these patients could be advised only to have an anti-hormone tablet. This test is not covered by Medicare at the moment, costs $4,500 and takes 2 to 3 weeks for the results to be made available.
So, to conclude, the media reports of this trial over-estimates the importance of doing this test in Australian breast cancer patients. Having the OncotypeDX test done on your breast cancer specimen may be worthwhile if you are found to have a cancer in the “grey zone” and are aged over 50yrs. In using this test now and even in the future when it is likely to be covered by Medicare, it is important that you discuss your own personal risk of breast cancer relapse with your treating medical oncologist and see how the TAILORx study results apply to you. In particular, the results of this trial are specific to using the OncotypeDX test and not to other similar tests that are out on the market.
Professor Arlene Chan & Dr Chris Lomma