Should All Breast Cancer Patients
Get Chemotherapy?

© 1997 by Ralph W. Moss, Ph.D.

An astonishing article appeared in the Journal of the National Cancer Institute (June 18, 1997). It is a so-called "news" article entitled "Chemotherapy Benefits Nearly All Early Breast Cancer Patients." According to the article, "two major trials have demonstrated that chemotherapy plus tamoxifen outperforms tamoxifen alone in nearly all groups of early stage breast cancer patients." Because of this, the article enthuses, "clinical practice is likely to change in more ways than one."

The patients, who were all part of the NSABBP program, had cancers that had not spread to the lymph nodes and whose tumors had estrogen receptors. The NSABBP is the program that was so plagued by fraudulent data a few years ago.

"Up to now," the article reports, "the standard approach for node-negative, ER-positive patients has been post-surgical tamoxifen alone."


In the current so-called B-20 trial, patients were assigned to one of three groups: either those receiving tamoxifen, or those receiving tamoxifen PLUS one of two chemotherapy regimens: either methotrexate and 5-fluorouracil (5-FU) followed by leucovorin, or cyclophosphamide, methotrexate and 5-FU (known as CMF).

The results in all three groups were very close. "About 90 percent of patients taking [either] chemotherapy plus tamoxifen were disease-free at 5 years compared with 85 percent of those taking just tamoxifen alone." So there was just a five percent difference between the two groups. But notice that this was "disease-free survival." It refers to the time to recurrence and is not the same as "actual survival. Actual survival, according to the article, was "also better." But the numbers are not given for improvement in actual survival: it is a fair assumption that this is less than the 5 percent advantage in disease-free survival. And so, on account of a less-than-five-percent advantage, all women with this type of breast cancer are now to be given chemotherapy. As if there were no drawbacks to chemo, in terms of both short and long term toxicity, not just hair loss, nausea, etc. but damage to the immune system and even the potential of death from some forms of treatment. There is also the considerable expense involved, an item that is of considerable interest to the pharmaceutical companies promoting the use of such drugs.

I thought it was interesting that the JNCI article does not state whether the advantage in either disease-free or actual survival was statistically significant. Nor is it clear what happens to women after the five year period. Nor does the article state what the actual survival rate is in women who do not receive tamoxifen, since there was simply no "no-treatment control arm" included in this study. It is therefore hard to assess the actual impact of treatment for this condition.

Perhaps chemotherapy is a proper treatment for some women in this category. I would urge patients to be very suspicious of any high-pressure tactics used to force them to take toxic drugs without due consideration given of all their options.

Ralph W. Moss, Ph.D. is director of the The Moss Reports for cancer patients. Dr. Moss is the author of eleven books and three documentaries on cancer-related topics. He is or has been an advisor on alternative cancer treatments to the National Institutes of Health, the National Cancer Institute, the American Urological Association, Columbia University, the University of Texas, the Susan G. Komen Foundation and the German Society of Oncology. He wrote the first article on alternative medicine for the Encyclopedia Britannica yearbook. He is listed in Marquis Who's Who in America, Who's Who in the World, Who's Who in the East, and Who's Who in Entertainment (as a film documentarian). This Web site does not advocate any particular treatment for cancer. We urge you to always seek competent medical advice for all health problems, especially cancer. Before consulting our site please read our full Disclaimer statement.

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