Millions with breast cancer could safely skip chemotherapy

Millions of people with breast cancer could safely avoid chemotherapy as scientists have developed a DNA test that can distinguish between patients who are likely to benefit from the treatment and those who are not, according to trial results.

The international study found that more than two-thirds of its participants could be spared the side of effects of chemotherapy and treated with hormone therapy alone.

Chemotherapy can cause fatigue, nausea, hair loss, a weakened immune system and fertility issues.

The study, led by University College London (UCL), involved more than 4,000 newly diagnosed patients over the age of 40 in the UK, Norway, Sweden, Australia, New Zealand and Thailand.

Scientists used a gene test called Prosigna to measure the activity of 50 genes involved in breast cancer growth and calculate a patient’s risk of the disease returning.

Those who received a low score – two-thirds of the group – were not treated through chemotherapy. The five-year survival rate of their group was 93.7%, compared with a 94.9% rate among patients who received chemotherapy as part of their care.

The primary treatment for breast cancer is usually surgery to remove tumours. Chemotherapy is often recommended afterwards to diminish the risk of return.

It is also regularly offered to people with early-stage breast cancer that has spread to the nearby lymph nodes.

Clinicians are concerned the treatment provides little benefit to those with the most common type of breast cancer, UCL said.

The university said more than 5,000 NHS patients a year could avoid chemotherapy as a result of the trial.

Karen Bonham, from Cardiff, took part in the trial and said the results are an “immense relief” and feel “like Christmas”.

The 64-year-old avoided chemotherapy thanks to the Prosigna test and has instead received radiotherapy and hormone therapy over eight years.

“Cancer diagnosis and treatment can be shocking,” she said.

“It certainly propels you into a world of uncertainty. Life priorities realign – you simply want to survive.”

The findings of the study will be presented at the world’s largest cancer conference, the American Society of Clinical Oncology’s annual meeting, in Chicago, United States, on Saturday.

Professor David Miles, a leading cancer specialist, described the findings as “practice-changing”.

“We can now confidently predict many patients will get no benefit at all, and therefore there’s no need for them to have the chemotherapy,” he told BBC’s Newshour.

He added that the test would allow doctors to “confidently define a large population of women who simply aren’t going to benefit and don’t need to go through all that unpleasantness for no benefit at all.”

“We used to give chemotherapy to 100 women to benefit 10, knowing that 90 didn’t need it,” he said.

Tanya Hutson, who was diagnosed with breast cancer in 2022 and had chemotherapy as part of her treatment, called the new DNA test “absolutely amazing”.

“It just proves what happens when money is put into research,” she said, adding that chemotherapy had been “brutal”.

“For all these people out there who don’t need it but are still getting it – it’s an absolute game changer.”

It is not known whether the findings apply to people under the age of 40, with a result still several years away, according to UCL.

BBC