Lani's two cents Improved survival of breast cancer over past 6 decades!

[Lani]

At the first breast cancer conference I attended Dr. Daniel Hayes stated that Stage IV disease represented uncurable disease, that no matter what the treatment, patients only lived about two years and the only question was what order to give treatments and, with respect to chemotherapy, was it better to give two together or two successively (and in what order)

Since then he has sat on many committees deciding what tests are to be given the approval of ASCO and other organizations, which ends up meaning which tests will be approved by Medicare ...and ultimately private insurances.

Such a predetermined attitude, it seems to me, stifles research into subtypes of metastatic breast cancer which respond differently (better) than others to specific types of treatment and an open mind into discovering, perhaps later, what these might be by improving testing(see my earlier post about 80% response rate to herceptin AVASTIN taxane where I opine that the FDA is about to take away approval of AVASTIN for ALL breast cancers, when a subgroup obviously responds beautifully to it). Dr Slamon often reports that he almost had to give up research on herceptin, as without giving it to the right group of patients (her2+s) it was not going to be deemed efficacious. Dr. Hortobagyi
of MD Anderson has said there may be a small group of Stage IVs with one or very few bone mets who might "theoretically" be curable. Very little research has been done on them.

All breast cancer researchers agree that breast cancers are very heterogeneous. Doesn't it therefore seem necessary to divide to conquer?

All this leads to the abstract I wanted to post...showing that all stages of breast cancer !,!!,!!!, and even IV are showing increased survival as we learn better how to diagnose and treat them (perhaps there is some contribution from the decreased popularity of post-menopausal hormone replacement therapy in the last few years, but I have yet to read how this might have brought these findings about, rather it seems to have decreased the number diagnosed in the first place) It is possible that it has prevented some more aggressive disease, but most articles state that those tumors felt to be due to/encouraged by HRT are of the less agressive type...

In any case, here it is:

ASCO Breast: Big Advances Seen in Breast CA Survival


NATIONAL HARBOR, Md. -- Breast cancer survival has progressively improved over the past 60 years, researchers affirmed in a single-center study.

The 10-year survival rate reached 76.5% for women diagnosed with any stage breast tumor in 1995-2004, Aman U. Buzdar, MD, and colleagues at MD Anderson Cancer Center in Houston discovered when looking back at outcomes at their institution.

This rate marked a steady rise from just 25.1% in 1944-1954 (P<0.0001 for trend), they reported at a press briefing in advance of presentation at the American Society of Clinical Oncology's Breast Cancer Symposium here
Explain to interested patients that a retrospective review of 10-year survival rates of breast cancer diagnosed and treated at MD Anderson Cancer Center from 1944-2004 found significantly increased survival over time for all stages.

Dramatic improvements were also seen across the various stages of cancer, which the group attributed to advances in early detection and combined modality treatment.

"This study shows us how our care of patients has evolved at a rapid pace," commented Jennifer Obel, MD, an ASCO Communications Committee member and moderator of the press briefing. "I think we can hope that the next decade will show similar gains."

The retrospective review included all 12,809 patients diagnosed and seen for their initial breast cancer therapy at MD Anderson between 1944 and 2004.

For local disease, the number of women alive at 10 years rose from 55.0% in the first decade of the study period when radiation therapy was the mainstay of treatment to 86.1% by 1995-2004 (P<0.0001 for trend).

For regional disease with skin or lymph node involvement, 10-year survival improved from a dismal 16.2% to 74.1% over the same period (P<0.0001 for trend).

"This is a dramatic shift because of the combined modality approach" -- often utilizing systemic therapy before or after surgery, Buzdar told reporters. "A dramatic shift in natural history is evident."

Even for those who presented with cancer disseminated to distant sites, improvements were seen from 3.3% alive at 10 years among those seen in 1944 to 1954 up to 22.2% by 1995-2004, again a significant trend at P<0.0001.

"This improvement can be attributed to a number of therapeutic agents available to treat these patients," he suggested in the press briefing.

The findings likely generalize to other centers since similar trends have been seen in the Surveillance, Epidemiology and End Results (SEER) databases, Buzdar noted.

And while the results represented outcomes at an academic medical center, the same treatments can be offered in community hospitals, he added.

Obel agreed. "The approach to cancer care in the U.S. has moved to a multidisciplinary coordinated approach across the country and in community hospitals," she told reporters.

Dramatic improvements in medication have played a role as well, she explained.

"Research advances are quickly taken up in the oncology community such that advances with the use of trastuzumab [Herceptin] in adjuvant therapy when they are presented at national meetings are quickly taken up at smaller, more regional hospitals," she said at the briefing.

The researchers reported having no conflicts of interest to disclose.


Primary source: ASCO Breast Cancer Symposium
Source reference:
Buzdar K, et al "Improving survival of patients with breast cancer over the past 6 decades: The University of Texas M.D. Anderson Cancer Center experience" ASCO Breast 2010.