Breast cancer care questioned

Breast cancer has been on the increase

Many women who survive breast cancer maintain an excellent quality of life for years after their initial treatment, a study has found.

However, the research also found that some follow-up treatments such as chemotherapy and the drug tamoxifen can worsen physical functioning in the long-term.

Only about a third of all women will benefit from the addition of chemotherapy, but all will be at risk for these potential side effects

Professor Patricia Ganz

These treatments are given to maximise the chance that the disease will not return.

The researchers say their findings should help doctors balance the benefits and side effects of prescribing long-term follow-up treatments after surgery, especially for women with very small tumours for whom the absolute benefits of treatment will be small.

The study, one of the largest of its type, was carried out by a team from Jonsson Comprehensive Cancer Center at the University of California at Los Angeles, the University of Southern California, and Georgetown Medical School in Washington DC.

The researchers examined how 763 women who had undergone surgery and follow-up treatments for breast cancer fared in the nine-and-a-half years following their initial treatment. The women were surveyed an average of 6.3 years after diagnosis.

Positive feedback

In general, the women reported that they were healthy, both physically and emotionally.

With time they were also less likely to suffer problems associated with the initial stages following surgery. These included hot flushes, night sweats, vaginal discharge, and breast sensitivity.

They did report a decrease in sexual activity, but the researchers suspect that this might simply be related to the normal ageing process.

However, in separate analyses, the researchers found that follow-up therapies did have a damaging effect on physical functioning - even many years after the therapy ended.

Women who were given these therapies had problems with vigorous activities such as running, lifting heavy objects and taking part in strenuous sports.

Some even had problems with household chores.

Lead researcher Professor Patricia Ganz told BBC News Online: "The therapy does seem to have significant affects on everyday physical activities, that become more apparent in the years after treatment."

Follow-up treatment

tamoxifen is a very safe drug, which has been shown to reduce the risk of developing cancer in the other breast by 40%

Dr Kate Law

Professor Ganz said chemotherapy and tamoxifen had proved to be very important in improving the survival rates of women with breast cancer.

However, she said that follow-up treatment should be carefully considered for women with small tumours of less than one centimetre in size if their life expectancy was unlikely to be compromised by sticking to surgery and/or radiation therapy alone.

She said: "Only about a third of all women will benefit from the addition of chemotherapy, but all will be at risk for these potential side effects.

"Women need to be informed about these late medical effects and weigh up their preferences for a small benefit, but possible long term consequences."

Dr Kate Law, of the Cancer Research Campaign, said a lot of research was currently being undertaken to identify which women would benefit from which treatment.

She told BBC News Online: "There might be problems giving chemotherapy to women with very small tomours who might not necessarily benefit.

"But tamoxifen is a very safe drug, which has been shown to reduce the risk of developing cancer in the other breast by 40%."

The research is published in the Journal of the National Cancer Institute.