SolveYourProblem Article Series: Breast Cancer
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Breast Cancer Preoperative Chemotherapy

This type of treatment has been utilized to treat women with large (almost always larger than 2 cm), palpable breast cancers. The use of chemotherapy prior to surgical removal of the cancer has a number of real and theoretical advantages:

1. It shrinks the size of the cancer and allows for easier removal with a better cosmetic result. The Italians demonstrated this and reported that a majority of women who would have required a mastectomy due to the size of their cancer could be treated with breast conservation surgery after preoperative chemotherapy. Multiple studies show less than 10 percent of cancers will grow during chemotherapy, and more than 50 percent will completely regress, based on palpation.

2. It allows for earlier administration of chemotherapy. Women do not have to wait for surgery and healing to begin treatment for possible micrometastatic cancer cells.

3. The cancer may be much less virulent and have less angiogenesis after preoperative chemotherapy, making surgery safer with less risk of spreading cells. This is theoretical and unproven to date, but frequently at the time of surgery there is little viable cancer present.

4. Accumulating clinical data has shown that women who have a complete pathologic response to the preoperative chemotherapy have a higher cure rate compared to those women with little or no response.

What is meant by "complete pathologic response"? When the breast tissue is evaluated under the microscope by the pathologist, there is no tumor left. The addition of Taxotere to the preoperative chemotherapy regimens has resulted in a doubling of the complete pathologic response rate in the breast tissue. For the women who have remaining cancer in the breast tissue or lymph nodes, doctors will often will do drug resistance and sensitivity testing on the tissue to determine if some type of alternative or backup chemotherapy agent might be effective.

A possible disadvantage of preoperative chemotherapy is that the extent of lymph node involvement may not be accurately determined. Previously, this was an important consideration for possible candidacy for high-dose chemotherapy with BMT. However, with the efficacy of this procedure in question, the number of involved lymph nodes may not be as important.

Indeed, what appears to be more important is whether the lymph nodes are cancer free when they are removed at the time of surgery. Preoperative chemotherapy, especially the Taxotere-containing regimens, increases the proportion of women who have negative axillary lymph nodes.

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