Chemo and Breast Cancer

Belinda44

Thanks for your post, Beesie!  As always great info.....  and I agree, we can't necessarily point to a specific person and say they survived because of chemo and by naming those celebrities, I wanted to point out that they had chemo and did not die from chemo as Leia and others seem to only know people who once they had chemo, died.  I have the opposite experience.  I know many people who had chemo and are thriving.  I just have a problem with someone saying/implying that by choosing chemo, you are choosing death.  Who knows why I am cancer free after 4 years? (her2+ and lymph node involvement).  Is it because of the chemo?  The surgery?  The radiation? The Herceptin? The tamoxifen?  The fact that I went "green" with all cleaning products, personal care products, etc...?  The fact that I continue to exercise and maintain a healthy weight as I always have?  The fact that I work full time and have a great social life?  The fact that upon diagnosis I gave up being a social smoker and stopped taking birth control pills?  Who knows????  All I know is I'm cancer free and will continue to do everything in my control to remain this way.  I rely on my medical oncologist for guidance and have also been to a more "holistic" doctor.  I'm not big on supplements but take fish oil and D3.  I add tumeric to my cooking.  I treat myself to reflexology.....

So, that's fine if Leia didn't do chemo and states that she'd rather die "naturally" than take it.  We all make choices, but again, please don't imply that taking chemo is a sure death sentence.  Leia says no to chemo (which since she is stage 1, not Her2+ with no lymph node involvment, probably makes sense) and she says yes to smoking.  Me, I said yes to chemo and no to smoking.  We all make our choices and everyone should do much research and seek out many opinions from qualified professionals and then do what feels right for them.  Ok, off my soap box now and off to zumba class.  Peace to everyone.

Anonymous

Thank you Beesie for posting those charts.

What I see in that table is that the death rate was actully rising through the 1980's, and started falling in the early 1990's with the advent of Tamoxifen, first in some pretty widespread clinical trials, and then in the late 1990's on the open market. 

Weren't they using chemo in the 1980's?

In younger women, where chemo induced early menopause would be a factor, the death rates did start going down a bit sooner, but really plummeted after the introduction of Tamoxifen, and they stayed down, meaning that deaths weren't merely postponed for a short time, but were actually prevented..

Has anyone else noticed that in those percentage of benefits comparisons, the percentage from chemo is always listed first?  Would the statistics look anywhere near as impressive if you were to list the percentage of benefits for hormonal treatment first? Could that be because chemo is more profitable than other treatments?

bluedahlia

OK, I gotta say it.  You people that are against Universal Health Care just proved how corrupt your system is if the oncs there are profiting from chemo.  OMG!  That stinks to high heaven. That would never happen here.

bluedahlia

Still doesn't mean chemo is not effective....just that there are opportunists and no one in government to control them.  I can't emphasize how wrong that is.

Beesie

PatMom, yes you are right that the table does show the annual death rate from BC increasing slightly during the 80s. But remember that almost all of those who die in any one year of BC were not diagnosed during that same year - they were likely diagnosed many years earlier.  

My understanding is that they started prescribing adjuvant chemo in the late 70s and it came into wide use in the 1980s. This means that many of the deaths in the 80s would have been patients who were diagnosed prior to the time when adjuvant chemo was widely in use. The annual mortality rate starts to decline right around 1990, which is exactly when one would expect to see this, given the lag times for the development of mets and the years of survival with mets. Remember that we are talking about women who were initially diagnosed with early stage breast cancer.

Tamoxifen was approved by the FDA for use for metastatic cancer in 1977. It started to be used on an unofficial/ad hoc basis for earlier stage BC in the late 80s and early 90s.  Wide usage for early stage BC came after that. So we would not expect to see the survival benefits of Tamoxifen in the mortality stats until the late 90s and 2000s, which is just when we do see a greater decline in mortality. 

Here is another article that talks about studies that have been done to measure the success of adjuvant chemo: http://jnci.oxfordjournals.org/content/96/24/1801.full  "The updated results of the sequential NSABP trials in lymph node-negative, receptor-negative breast cancer add to the growing international database that confirms the lasting benefit of adjuvant chemotherapy."

bluedahlia

Patmom, we know chemo is not as effective for er+pr+ cancers but very effective for trip neg or Her2+++ cancers, therefore logic dictates that tamoxifen would be a big part of the equation as most cancers are er+pr+.  You're not revealing anything we didn't already know.  And as for your other theory, instead of bad-mouthing Obama, let the man do his job.  Maybe some of the gouging will stop.

AlaskaAngel

Internationally speaking, with the exception of the argument in favor of greater access to chemotherapy for those who are metastatic, breast cancer treatment in the US with chemotherapy is generally seen as excessive by other parts of the world, even by the rest of the "developed" world.

Morally, one has to consider that overtreatment for the majority in order to benefit a very small minority also has its costs and those costs are not small. How much of the toxic chemicals being used for cancer patients are affecting the environment in ways that produce more cancers? How many patients in the rest of the world are prevented from receiving basic treatment due to the massive amounts of money being spent on overtreatment of the majority in order to treat a minority in the developed world?

AlaskaAngel

sweetbean

princess123, 

I didn't ask my chiropractor about whether or not I should take chemo.  He was really pushy, insisting that I didn't need any conventional treatment, including surgery.  He wanted me to go to Mexico and do the Gerson Therapy.  He put a TON of pressure on me.  For every woman who has experienced a lot of pressure from their oncologists, I can say that that road goes both ways.

I researched it and several other alternative methods and couldn't find enough success stories of women  like me  (a 5cm tumor and lymph node involvement) who had done purely alternative treatments and lived to tell about it.  So I went the complementary route - all the conventional and lots of alternative.   

 I don't see him anymore.  I can't stand the pity I see in his eyes - he thinks I have destroyed my life, another victim.  It's annoying.  

 I still have a hard time believing that oncologists buy their drugs directly from the companies.  That just doesn't make sense, from a business perspective. 

Anonymous

bluedahlia wrote:

 "And as for your other theory, instead of bad-mouthing Obama, let the man do his job."

????????????????

bluedahlia

Patmom, you said:

Could that be because chemo is more profitable than other treatments?  

in otherwords the onco price gouging.

Beesie

Patmom, to add to my earlier post, it's probably easier to use the survival stats table if we want to try to tie early stage treatment options to mortality/survival.  Specifically:

. 

Year of Diagnosis:...........'75-'79..............'80-'84.................'85-'89.......................'94 

Treatment Options:...Minimal Chemo...Some Chemo...Widespread Chemo.....Some Tamox.

19 Year Survival Rate:.......52.6%...............55.0%.................65.2%................Not yet avail.

14 Year Survival Rate:.......57.2%...............59.2%.................69.1%.....................76.5%

10 year Survival Rate:........62.6%...............64.6%................73.5%......................79.2% 

I've quoted the 19 year survival rate instead of the 20 year because the 20 year data isn't yet available for the '85-'89 period and I used the 14 year survival rate instead of the 15 year because the 15 year data is yet available for 1994. 

AlaskaAngel, I would argue that those who benefit from chemo is more than a "very small minority".  We are talking about saving lives here. When you consider that in 2011 approx. 250,000 women in North America will be diagnosed with invasive BC, if we assume that 50% will get chemo and that there is a 3% - 5% increase in survival from the chemo (being conservative), this represents 3,750 - 6,250 additional women surviving breast cancer - every year.    

Are many women getting chemo who really don't need it and/or don't benefit?  Absolutely.  There is overtreatment. And medical science is not yet precise enough in being able to identify who will benefit from chemo and who won't. But this isn't a hidden issue. There is no conspiracy here and no attempt to pull the wool over anyone's eyes. This is a well understood issue that is being worked constantly within the scientific and medical communities.  Everyone wants to find the answer to this dilemma.  Here's a very informative article that discusses this:

http://www.nature.com/nrclinonc/journal/v8/n5/full/nrclinonc.2011.19.html 

Anonymous

"Chemotherapy produced a small, but real, improvement in survival -- of about two to three lives saved per 100 -- for women in their 50s and 60s whose cancer was either node-positive or node-negative."

That statement means that 97 or 98 women out of 100 who do adjuvant chemotherapy had to deal with all the life changing and life threatening side effects of chemotherapy with no benefit at all.  Not to mention the financial cost.  How many of those women die earlier, maybe not immediately, but years earlier than they otherwise would have from cardiac damage, or pneumonia, or lose function due to neuropathy?  The price of human suffering from chemotherapy is real, and significant, and needs to be weighed against the very small potential benefit for most women. 

If you believe that chemo helped you or saved you, that is your right, but that doesn't mean that anyone should ever be pushed into doing chemo because you believe it works. 

Anonymous

Sweetbean, read the article above and AA's post. The system under which cancer doctors in the U.S profit on chemotherapy drugs came into being more than two decades ago. I knew this already. I just didn't know to what extent. People go where the money is, and you'd like to believe it's different in medicine, but it's really no different. I wonder just how many people are being overtreated as a result.

AlaskaAngel

I understand your response, but your answer did not address my questions, despite your statements that "...this isn't a hidden issue. There is no conspiracy here and no attempt to pull the wool over anyone's eyes."

If it isn't a hidden issue, why don't you address the questions I asked? Chemo drugs are carcinogenic.

1.  How much of the toxic chemicals being used for cancer patients are affecting the environment in ways that produce more cancers?

2. How many patients in the rest of the world are prevented from receiving basic treatment due to the massive amounts of money being spent on overtreatment of the majority in order to treat a minority in the developed world?

Anonymous

Gosh, I hate stats....

PatMom "That statement means that 97 or 98 women out of 100 who do adjuvant chemotherapy had to deal with all the life changing and life threatening side effects of chemotherapy with no benefit at all.  Not to mention the financial cost.  How many of those women die earlier, maybe not immediately, but years earlier than they otherwise would have from cardiac damage, or pneumonia, or lose function due to neuropathy?  The price of human suffering from chemotherapy is real, and significant, and needs to be weighed against the very small potential benefit for most women"

I came to the exact same conclusion. I shall be very lucky indeed should I fall within the "about two to three lives "saved" per 100".  The "about" sounds approximate....

Should I survive treatment, I shall credit my health status at dx and my lifestyle

More stats:

"we found that the incidence of second cancer has substantially increased among female breast cancer patients over the past 25 years. Observed changes in incidence may partially reflect the effect of treatments"

http://www.jstor.org/pss/29736476?searchUrl=%2Faction%2FdoBasicSearch%3FQuery%3DBREAST%2BCANCER%26acc%3Doff%26wc%3Don&Search=yes

bluedahlia

I find it quite suspect that all these new posters are joining the choir, and old posters who just contradict themselves because they like to be ornery and combative.  I'm out of here.  I don't like subterfuge.  Like I said on another thread......need propofol!  Ciao!

sweetbean

Ok, that was an interesting article.  I still don't believe that the majority of doctors are pushing chemo to make a profit.  They legitimately believe that it is the right course of action, one that provides the best chance for survival and that is why they push it.   I realize that they are making a profit - I just don't think that most of them are in it to make a buck.  Let's face it, doctors are in no way the rich people in our society anymore.  That used to be the case, but it isn't so anymore.  If doctors were in it for the money, they would go into business or start-ups or some industry with a chance to make millions.  Medicine is no longer that field.  

I do believe that people are overtreated and I also believe that conventional oncologists make a grave mistake when they discount the importance of not only diet and lifestyle, but the many potential benefits of alternatives.  Certainly, acupuncture has been proven to prevent neuropathy in chemotherapy patients.  Stuff like that.  Patients would have a better response to treatment, a better quality of life both during and after treatment, and a solid survivorship plan if doctors expanded their view of what it takes to cure cancer.  

Ang7

Nicely said sweetbean!

Beesie

I love stats.  I just hate when they are misused and misstated and misrepresented and denied.

"If you believe that chemo helped you or saved you, that is your right, but that doesn't mean that anyone should ever be pushed into doing chemo because you believe it works."  

I agree 100%.  I also believe that no one should ever be discouraged from having chemo because you believe that it doesn't work.

That's the reason I'm posting here.  We need to present and discuss the facts, not opinions or simply what we choose to believe.  When provided with the facts - both the pros and cons - each patient can decide for herself whether or not to do chemo.  

It's probably the case that nobody who's diagnosed with BC wants to do chemo. But chemo is recommended to many women and a percentage of the women who have chemo will survive breast cancer because of it. That is proven.  But chemo doesn't help everyone and the side effects for some can be debilitating. It is fair and appropriate (and advisable, even) to have an even-handed discussion about chemo, talking about the potential benefits (it is life-saving for a certain percentage of the women who have it - the percentage varies depending on the age of the patient and the diagnosis) and the potential risks (toxicity, side effects, etc.). What's not fair or appropriate are statements, such as some in this thread, that either have no basis in fact or are vast exaggerations or that focus only the negatives about chemo.

What worries me is that if someone newly diagnosed comes here, with chemo recommended by her doctors but not wanting to take chemo (a pretty common position to be in), and then reads these unbalanced and often incorrect or exaggerated negative statements about chemo, without also reading about the potential benefits, this might be enough to nudge her over the edge and solidify her decision to not have chemo.  For many women, there will be no harm done. But for someone, this decision will be fatal.  As a member of this discussion board, I can't live with that. 

That's not to say that I believe that everyone should have chemo if their doctors say they should. Having all the facts and choosing to not do chemo is one thing.  Choosing to not do chemo because of misstatements and a twisting of the truth is a whole other thing. That's why I've tried to present a bit of factual information about the efficacy of chemo - to add some balance to other things said in this thread, and to contradict some blatantly false statements that have been made. As a member of this board, I felt that I had a responsibility to do that.

I did my part and I'm out of here. And AlaskaAngel, the reason I didn't respond to your other points is because to me they are completely irrelevant to the decision-making process that each individual must go through for herself on whether or not to have chemo.  Women here may be over-treated and women in other parts of the world may be under-treated but when someone is making a decision about chemo for herself, the only thing that counts is herself.  I'm not interested in the politics of chemo.  I'm interested in ensuring that we don't mislead someone down a path that could lead to her death. 

Anonymous

This thread is on the alternative forum (which a group concerned about anyone saying anything negative about chemo have already gotten separated from the complimentary and holistic forum) and does not show up on the active topics.  The only newbies who will stumble onto it are already seriously looking for answers that do not include chemo, so the self appointed censors don't need to worry about this thread turning someone against chemo anymore.

thats-life-

So am I Beesie. If you want the evidence, i will provide it. I will try to do so tonight if i have the time. I use personal opinion as opposed to confronting stats out of respect for those who do standard treatment. But as you say,  balanced, science based evidence is necessary. It seems. Im off to the oncs, hopefully will be able to upload the information later.

AlaskaAngel

We all share the same world and its limits, no matter where we live. Adding carcinogens to the part of the world where we each live, is part of why we continue to get cancer in the first place. Whether it is the cancer you or I have, or the cancer that our family or neighbor has, as a result of the use of carcinogens to treat it, we are not separate from that cause.

A.A.

Anonymous

In all honesty, I have not had the courage to read any of the stage IV threads knowing full well what my future holds, (stats becoming totally irrelevant). Anyone new on BCO need only read the active topics titles to get a grand tour of what conventional treatment has in store for us while scaring the hell out of anyone brave enough to enter the topic. In the end, what stands out is the incomparable strength, courage and determination each one of us can muster while showing the utmost respect for our fellow sisters.

Hindsfeet

I believe that Beesie is fair and means no harm. She is right ... no one should be pushed to do chemo or not do chemo. Everyone dx with cancer needs to do their own research. Chemo or not doing chemo is a personal decision. We must take responsibility for whatever happens. I've followed the advice (without question) of doctors in the past, and the doctors failed to educate me on either the disease, and or the side effects. They took no responsibility for mis dx or giving me wrong treatment. Life has taught me to be more cautious, to question, to research and to trust my basic instincts. I am no longer timid by "professionalism". I am my best advocate!

With all due respect, Beesie, the question I have is doesn't everyone have cancer cells floating throughout their body? Doesn't our immune system kill these rough cells? If that were true then every human needs to do chemo to kill off the few stray cells that got away. I don't mean to be sarcastic here...just seems logical to me.

I have a difficult time seeing why we need to do chemo for early stage cancers. For later stage cancers it might be a different story.. although not for me,I would be too scared to do it.

Anonymous

ThatsLife {{{{{hugs}}}} really hoping for good results sister

1Athena1

Beesie, you say: 

We need to present and discuss the facts, not opinions or simply what we choose to believe.  When provided with the facts - both the pros and cons - each patient can decide for herself whether or not to do chemo. 

That is true, but one crucial fact we too frequently ignore in the fight over specific treatment is that "facts" themselves --and pros and cons-- change a lot in breast cancer. Science is fungible because it depends on technology and discovery and facts, as judged by a consensus of experts, are therefore equally subject to change. Good, scientifically sound treatment today is frequently not so next season  after the ASCO conference.

I said in an earlier post on this thread that even since I was dx'd treatment protocols have changed just on two issues that were pertinent to me: Tamoxifen and Zometa. Things experts will confidently swear by they must frequently swallow following new research. This hysteria or fast-paced environment (choose your term) exists for obvious reasons - because people are dying and the world is desperate to save lives. It is led by fear as much as anything else. That is understandable, but not always the most scientifically productive way to proceed, IMO.

That is why we need to show HUMILITY in the debate about chemo. There is almost no science showing benefits of chemo for early stage breast cancer. There are numbers but these have changed and frequently come under question. Even pro-chemo protocols have changed. For example, a person with any nodal involvement is no longer a shoe-in for chemo if she has a low-grade tumor. Only time will determine the wisdom of this approach.

And that onco-type test that so many swear by? there is no long-term data to verify its prognostic value. The test is based on a known genomic assay, but the jury is out on how reliable it is. As I point this out I should also mention that I would have had it done if it had been offered to me, but I had nodal involvement, so the protocol was chemo no matter what anyway - I might be told something different today, however.To complicate things more, people who get chemo for early stage BC almost always get another treatment as well, including surgery, which can lead to the excision of the visible tumor. And chemo has not been tested against placebo. New chemo agents are usually tested against existing ones. So we do not have good evidence of efficacy.  This should not be a black and white discussion - too often on BCO it is because people feel that their personal decisions are being attacked. But that is often an overreaction, IMO. The decision that best fits person a does not necessarily fit person b. We all have unique medical histories, values, families and circumstances.

Someone asked if chemo cures some leukemias. The answer is YES - it actually cures some rare cancers, including childhood leukemias and thus pediatric cancers are not the automatic deaths sentences they used to be. Yes, a few Cancers CAN be cured, by chemo or other measures. Not ours. For large organ cancers, the chemo story is very dismal for overall survival, though it may prolong life in some cases. A few rare cancers like penile, testicular and  (sp.) tumor respond quite well.

I almost wish we hd a humility thread in which each person coulfd jus5t list their dx, tx and time since dx. I wager thyat we would se something interesting: a lack of predicitve value for any one treatment. Granted, the thread would not be scientific.

Ang7

Nancy said "I consulted with 4 different doctors prior to chemo, and not one mentioned permanent SE's."

That really bothers me.  My oncologist actually sat down with my husband and I and went over every terrible side effect that could possibly happen with my chemo. 

The one thing that I had to ask her myself was if the hair loss could be permanent.  She said yes, but I am not sure if she would have told me that if I had not asked about it.

artsee

OK, I've have to admit I've been lurking on this thread to maybe learn something and to see different views that everyone here has.

I came across a post where an individual said " most people that had Chemo died". Are you insane? How can you even think to make a statement like that much less post it! You must have fallen off a bar stool and hit your head!!!!

I happen to know many, many people who have lived for years and are perfectly fine after having chemo. You really need to asses your info before you say something that strong, on these boards.

Anonymous

Well, we (alternative minded people) all know that medical studies are  often rigged to make medications look safer than they actually are, right?  Clinical trials are funded by pharmaceutical companies about 80% of the time, so participants for studies are "carefully selected" to achieve favorable outcomes.  That's nothing new.  But what I learned very recently was that, according to Dr. David Getoff, ( one of the doctors who spoke during the Healing Cancer World Summitt) ..... during clinical trials, researchers are legally allowed to factor out participants who did not complete the study. That's even if they die as a result of taking the drug.  In other words, participants that died after taking chemo, which was the example he used, could be listed as having   "dropped out" of the study.  Do you ladies remember hearing that? Did I understand him correctly?

Anonymous

Nancy, if the doctors had told you that chemotherapy could cause serious long term/permanent SEs, would that have influenced your decision?