Europe South Asia Asia Pacific Americas Middle East Africa BBC Homepage World Service Education
BBC Homepagelow graphics version | feedback | help
BBC News Online
 You are in: Health
Front Page 
UK Politics 
Medical notes 
Background Briefings 
Talking Point 
In Depth 
Friday, 10 March, 2000, 15:15 GMT
Battle rages over breast cancer treatment

If breast cancer spreads, it is very hard to treat
The death toll for advanced breast cancer is so high that any treatment that could make a difference is regarded as a "Holy Grail" by scientists.

But controversy over one potential treatment has at times more resembled a soap opera than dignified scientific debate.

This has the makings of a medical tragedy of Greek proportions.

Dr John Crown, cancer expert
Many argue that research results mean it is now unethical to put the women through a highly unpleasant treatment which has no discernable benefit.

But those supporting it say there is a chance that a lifesaving treatment is about to be ditched because of a combination of flawed science and an extraordinary research scandal in South Africa.

In more than a third of UK patients, the breast cancer spreads widely beyond the breast, and patients in this situation are unlikely to be alive five years later.

Returning cancer

These breast cancer cells show some response to normal chemotherapy drugs, but they almost inevitably return.

A decade ago, researchers' main hope for the future lay in a single, massive dose of chemotherapy, which would hopefully deal with the rogue cells.

Women faced with a desperate prognosis were keen to try anything which offered hope, and clinical trials began springing up across the world.

Now, on the face of it, that hope looks forlorn.

The chemotherapy is powerful and unpleasant
Early in March, the New England Journal of Medicine published what could be the final blow to the treatment.

The results, although already widely known in the cancer community, were given added prominence by being rushed into print by the journal ahead of their expected publication date.

The trial, in which 110 women received the high-dose treatment, and were examined three years later, showed no significant difference between the fate of these women and those treated conventionally.

An accompanying editorial, by US cancer expert Dr Marc Lippman called for no further study of the treatment, as its unpleasant nature could no longer be justified.

"To a reasonable degree of probability, this form of treatment for women with metastatic breast cancer has been proved to be ineffective and should be abandoned," he wrote.

There have now been six similar trials suggesting the treatment does not work, but, in effect, the killer blow was struck in February - and involved the only research which claimed to have found the opposite.

Professor Werner Bezwoda, working at the University of the Witwatersrand in South Africa, presented a paper at the American Society of Clinical Oncology Conference last year showing an increased survival rate - and lower relapse rate among women given high dose treatment.

This was hailed as ground-breaking evidence, turning the previously pessimistic view of the treatment on its head.

Discredited research

However, last month, in an extraordinary turn of events, Dr Bezwoda admitted he had "faked" the results by comparing high-dose patients not with conventionally-treated women, but with those given other experimental drugs.

He said that this "serious breach of scientific honesty" was motivated by a desire to make the his presentation "look better".

In response, the biggest health insurer in the US, Aetna, said it would now refuse to pay for its customers to undergo high-dose chemotherapy.

Despite the discrediting of the South African research, some scientists still believe that high-dose chemotherapy could be the way forward.

Dr John Crown, a consultant medical oncologist from St Vincent's University Hospital in Dublin, who chairs another European study into the treatment, said that there was a danger that the "baby could be thrown out with the bathwater" following the South African scandal.

He claims that each of the other six published studies have flaws which render their findings pointless.

Many have given their patients as many as six courses of conventional chemotherapy before they even start the high dose treatment, and Dr Crown says this cannot help but skew the result.

"This has the makings of a medical tragedy of Greek proportions.

"This is the most controversial area in cancer today."

However, he said that the weight of the published studies now makes it extremely difficult to set up any future studies.

"I believe questions about high dose chemotherapy have not yet been answered," he added.

Breast cancer is the most common cancer in UK women, and thousands, like Dr Crown, still hold on to hope that an effective treatment can be salvaged from the argument.
Search BBC News Online

Advanced search options
Launch console
Internet links:

The BBC is not responsible for the content of external internet sites

Links to other Health stories are at the foot of the page.

E-mail this story to a friend

Links to more Health stories