Nodal
status and choice of adjuvant systemic therapy
Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 2 2000
Play
Audio Below:
I
think that we’re now past the time when we have to test every
concept separately in node-negatives and node-positive patients.
There’s no evidence anywhere with tamoxifen or with chemotherapy,
that there is any kind of interaction between the therapies and
the number of positive nodes. For example, with tamoxifen –
tamoxifen has the same reduction in annual odds of death if you
have 20 positive nodes, as if you’re node-negative. We have
a tendency to use tamoxifen in node-negatives, while 20 positive
nodes you say, "Oh, we have to do something else". But
the size of the effect, I mean the benefit, the proportional effect,
is going to be a reduction in annual odds of around 25, 26, 27%
in both of those groups. And I don’t think we have to test
these things separately. Now, we may choose, because as doctors
we always weigh the cost – that is, the toxicity with the benefit.
You might make different choices because of the cost/benefit ratio;
that is, how much you’re paying for a given benefit and if
your risk is higher, you’re willing to pay more for it.
