Expert Point of View: Sandra M. Swain, MD, FACP and Eric P. Winer, MD

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Commenting on the study presented by Dr. Wolff at the 2012 San Antonio Breast Cancer Symposium, ASCO President Sandra M. Swain, MD, FACP, Medical Director, Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, said she found it “disturbing” that about half the population had node-negative disease. “They were treated prior to the availability of the Oncotype DX recurrence score, when we were overtreating many patients. These findings give us another reason to be careful about unnecessary treatment,” she offered.

Eric P. Winer, MD, Professor of Medicine at Harvard Medical School, Boston, agreed, and told The ASCO Post, “Generally speaking, the risk of leukemia with chemotherapy is quite small. The absolute risk is about half a percent, and because the general population has a risk that’s greater than zero, we are talking about an excess risk of approximately 3 or 4 cases in 1,000 women. For a treatment with a big benefit, that risk is a relatively small price to pay. But if we are talking about treatment that has a smaller benefit, then the leukemia risk is something to consider. It’s among the reasons why we have to think very carefully about treating women with very early-stage disease or those whose tumors have biologic features that suggest a very limited benefit from chemotherapy. Unfortunately, we cannot dial down the toxicity based on the amount of benefit.” ■

Disclosure: Drs. Swain and Winer reported no potential conflicts of interest.

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