Chemotherapy Before Breast Cancer Surgery?

Depending on the type of tumor, it can be the wisest option

Feeling “fantastic” now— Jill Kardos overcame breast cancer thanks in part to presurgery chemotherapy. She’s shown with her father, Bruce DeHart of Easton, who drove her to her chemotherapy treatments.

Options in Breast
Cancer Surgery

Lumpectomy—Removal of the tumor only, leaving the breast intact. This breast-saving option is appropriate for about two-thirds of newly diagnosed patients today.
Mastectomy—Removal of the entire breast. This option is still necessary if the tumor is large, if cancer is in several areas of the breast or body, if the patient has had previous radiation for breast cancer, or if there is a family history of breast or ovarian cancer

When your doctor tells you you have breast cancer, your first impulse is to get rid of that tumor. Hold on! As Jill Kardos discovered, an immediate surgery isn’t always the best treatment.

The 36-year-old Hellertown woman was diagnosed in October 2006. She used Lehigh Valley Hospital’s Breast Cancer Consultative Service to help her decide on a treatment course that began with eight rounds of chemotherapy to shrink her tumor. By the time of her lumpectomy the following May, the tumor had disappeared. Just to be sure, her surgeon removed some nearby tissue and lymph nodes—and it all tested negative.

“I felt the tumor begin to shrink after the third round of chemotherapy,” Kardos says. “I was thrilled, because it confirmed that the treatment was working.”

Traditionally, breast cancer patients receive chemotherapy after their surgery, to kill any remaining cancer cells. “The main advantage to doing chemotherapy first is that it gives more women the option of a breast-saving lumpectomy rather than a full mastectomy,” says Gregory Harper, M.D., oncologist at Lehigh Valley Hospital and Health Network.

For women whose biopsy reveals cancer in the lymph nodes or whose cancer has spread, starting chemotherapy immediately (instead of waiting until a month after surgery) is a definite advantage. The chemotherapy targets both the breast tumor and any microscopic cancer cells that may have escaped the breast.

“Research over the past several decades has helped us analyze various types of breast cancer,” Harper says. “We now can tailor the treatment to the individual patient based on her heredity, menopausal status, the stage of her tumor and whether it’s receptive to hormones or proteins that promote cancer growth.”

In tumors that are “estrogen- or progesteronereceptor- positive,” those hormones stimulate the tumor’s growth, and anti-estrogen therapy (with tamoxifen, for example) is effective. In tumors coated with a specific tumor-stimulating protein, treatment involves neutralizing that protein.

Kardos’ tumor was of a type called “triple negative”— not hormone-receptive and not coated with the protein. Chemotherapy is especially effective in cases like hers.

Before her diagnosis, Kardos was unaware that there are many different ways of being treated for breast cancer. “Knowing what type of tumor you have and following the advice of your physicians can really help you through this difficult time,” she says. “I feel fantastic now, and I’m looking forward to the rest of my life cancer free.”

Want to Know More? Click here for Individualized Therapy
for Breast Cancer. To learn more about the Breast Cancer Consultative Service call 610-402-CARE.

Published from Healthy You Magazine, May-June 2008

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