Breast cancer team reduce risk of surgery

A pioneering treatment for breast cancer, which kills 13,000 woman in Britain each year, has been discovered by doctors.

Women with large tumours usually have surgery to remove either the lump or the entire breast. But doctors at the Royal Marsden NHS Trust believe they may have found a safer, more effective treatment.

The new method relies upon giving the woman chemotherapy prior to an operation. In the past there was no means of measuring the success of drugs used, but Dr Paul Ellis, a research fellow, believes his team may have pinpointed the way the drugs work.

"We have shown for the first time that chemotherapy causes cancer cells to self-destruct," Dr Ellis said at the launch of the Institute of Cancer Research's annual report yesterday. "The drugs trigger a complex chain of events known as apoptosis in which cells destroy themselves.

"It is early days yet, but we have already seen that treatment with drugs before surgery can shrink the tumour or even cause it to disappear," he said. "The problem is that, until now, we've had no way of knowing if the drugs that one patient has responded to will benefit someone else until her course of treatment is complete.

"Inevitably, this means some women are suffering several months of unpleasant treatment with little or no benefit."

In clinical trials at the Royal Marsden, which have involved around 30 women so far, doctors perform a biopsy using a fine needle to remove cells from the tumour before chemotherapy is started, and then again afterwards.

By measuring the rate at which cells self-destruct, doctors will be able to determine the most appropriate drugs to use. In other words, it should be possible to provide tailor-made treatment for patients.

In successful cases the need for major surgery - including the removal of one or both breasts - has been lessened or avoided.

"No two breast cancers are the same," said Dr Ellis, whose work won him the prestigious 1996 ASCO Fellowship Award.

"Every patient has a biological make-up that is slightly different. We are applying technology so that we can fingerprint each patient's tumour early on, so the woman does not have to undergo unnecessary treatment.What we don't know is whether it gives women better survival rates."

But Ian Fentiman, deputy director of the Imperial Cancer Research Fund's clinical oncology unit at Guy's Hospital, advised caution. "It would be nice to think this is the end of mastectomies, but it isn't," he said. "We have to say the results are early, and we do not know that they are necessarily going to lead to improvements.

"When we did a similar study at the ICRF we found that when we explained to patients exactly what was involved in chemotherapy, then surgery, then radiotherapy, only 50 per cent were prepared to go through with it. The rest of [the] patients opted just to have a mastectomy, rather than go through all that."