‘Micro tumors’ rise on the risk scale

Study may alter treatment for breast cancer

By Marilynn Marchione
Associated Press / August 13, 2009

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Breast cancer patients with even the tiniest spread of the disease to a lymph node have a much higher risk of it recurring years later and may need more treatment than just surgery, new research suggests.

For years, doctors and patients have struggled with what to do about a microscopic tumor or stray cancer cells in a lymph node.

Women with “micro tumors’’ usually are given estrogen-blocking drugs, chemotherapy, or both; those with isolated cancer cells usually are not, because those were thought to be of low concern.

The new study challenges that view. It suggests that either type of metastasis, or spread, raises a woman’s risk of having cancer show up in the breast or anywhere else in the next five years by about 50 percent.

“This took an area that was very gray and I think made it black and white,’’ said Dr. Linda Vahdat, director of breast cancer research at Weill Cornell Medical College and an adviser for the breast cancer patient website of ASCO, the American Society of Clinical Oncology.

“I think it will influence treatment,’’ she said of the study. “If we’re considering treating the patient, we probably should.’’

Dr. Daniel Hayes, director of breast cancer treatment at the University of Michigan, agreed.

“It really does look like our biases are wrong,’’ he said. “For the first time, it suggests that isolated tumor cells or micrometastases do have biological significance.’’

Vahdat and Hayes had no role in the study, which was done by researchers throughout the Netherlands. The results are in today’s New England Journal of Medicine.

Meanwhile, another study out today suggests doctors have been giving bad advice regarding lifting weights.

For decades, many doctors warned that lifting weights or even heavy groceries could cause painful arm swelling. New research shows that weight training actually helps prevent this problem.

“How many generations of women have been told to avoid lifting heavy objects?’’ Dr. Eric Winer, breast cancer chief at the Dana-Farber Cancer Institute in Boston, lamented after seeing the surprising results of the new study.

“Women who were doing the lifting actually had fewer arm problems because they had better muscle tone.’’

The study was led by Kathryn Schmitz, an exercise scientist at the University of Pennsylvania, and funded by the federal government. Results are in today’s New England Journal of Medicine.

More than 2.4 million Americans are breast cancer survivors, and the study could mean a big difference in their quality of life. Cancer treatment-related arm swelling now appears to be one of many ailments made better by exercise - not worse, Schmitz said.

The Netherlands study is not ideal: It simply observed a large number of women, rather than assigning some to get treatment and comparing how they fared compared with others who were not treated.

The study also was done at a time when treatment was less aggressive and in a country where doctors had been treating breast cancer more conservatively than in the United States.

In the United States, many women with early stage breast cancer are given hormone blockers.

“The big issue is, should these patients also get chemotherapy?’’ Hayes said.

Not all women benefit from chemotherapy, however, even when their risk of a recurrence is high, Winer said.

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