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Use bone marrow cells to predict breast cancer recurrence

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     A new study that was recently published in the New England Journal of Medicine suggests that traces of malignant cells (known as micrometastasis) may be used to predict the prognosis of breast cancer. Patients have micrometastasis in the bone marrow may have poor prognosis of breast cancer compared to those patients who do not have cancer cells in the bone marrow. Research shows that micrometastasis may be an indication of the extent of the disease and may predict the need for chemotherapy. At the current time bone marrow examination is not routinely undertaken for patients who are diagnosed with breast cancer.

    These new finding published in the recent issue of New England Journal of Medicine is based on a study consisting of more than 4,700 women with invasive breast cancer (stages I, II, or III) who were followed for a period of ten years.

    Micrometastasis was a common finding and was seen in 30.6 percent of the patients. During the follow up period women with cancer cells in their bone marrow were found to have significantly poorer outcomes in terms of both disease-free survival and overall survival, when compared with women without such cancer cells.

    It is known that many of the patients who are receiving chemotherapy may not need it. At the current time the methods used to identify those who really need chemotherapy include tumor size, and lymph node status. If proven this method could become a powerful tool in determination of the need for chemotherapy. The reliability of this new technique could be determined only by further carefully designed clinical trials.

    As per Stephan Braun, M.D, who is the lead author of the study, about 90% of the patients with breast cancer receive chemotherapy for the prevention of recurrence, but chemotherapy may actually be required by only 25% because 75% of the patients are cured by surgery. For at least 60% of the patients it is considered to be an over-treatment. Braun believes that those patients who really need chemotherapy would be identified by this new technique.

    Braun also said that if after chemotherapy the tumor cells are completely cleared it is believed that the patients have been treated successfully.

    Dr. George W. Sledge, who is a professor of medicine, pathology and oncology at the Indiana University, says that in case if someone has a worse prognosis, this technique may be valuable to know if a change of therapy for improving prognosis is needed. However he is not sure about how this would help as adjuvant therapies like chemotherapy or hormonal therapy are offered to most of the patients with tumors bigger than one centimeter.