Caring Currents

New Scoring System Simplifies Breast Cancer Treatment Decisions

Last updated: Sep 24, 2008

It starts the minute you or someone you love gets a diagnosis of breast cancer: Decision after exhausting decision. Lumpectomy plus radiation, or mastectomy? Partial or full mastectomy? Reconstruction during or following mastectomy, or not at all? Then there's the biggest decision of all for those with early stage cancer: chemo or no chemo?

The agonizing choices are one of the biggest reasons breast cancer can be so stressful for both cancer patients and those trying to help them negotiate the treatment maze. That's why we all reacted with so much excitement yesterday when a group of researchers unveiled a new predictive tool called the PEPI score that doctors and patients can use to determine what treatment is necessary.

PEPI (which stands for the mouthful "preoperative endocrine prognostic index") offers a way to gauge a woman's risk of recurrence, which is the $64,000 question that must be answered in order to determine who needs chemo and who doesn't.

The experts at the Siteman Cancer Center at Washington University and Barnes-Jewish Hospital who developed the new system hope it will take the guesswork out of breast cancer treatment decisions by weighing four factors:

  1. The size of the breast tumor  
  2. Whether cancer is present in nearby lymph nodes  
  3. How fast tumor cells are multiplying  
  4. Whether tumors lose their estrogen receptors

Women with a score of 0 have almost no risk of recurrence and could skip chemo, while those with a score of 4 or above have a high recurrence risk and need the most aggressive treatment possible. Those with scores from 1-3 fall into an intermediate group.

The research, published in the Journal of the National Cancer Institute, was also innovative in the way it arrived at the score: The researchers had women with stage 2 and 3 ER-positive cancer take anti-estrogen therapy for four months before having surgery, then evaluated tumor characteristics to see how they responded. Then they used the short-term response to predict long-term response. (When it comes to developing predictive tools, it's a relief to know the research is patient-based rather than theoretical.)

Another reason this study is important is that it's good to see research focusing on ways to make the treatment process easier on patients, a serious issue that often gets overlooked. With recent research on the mind-body connection showing that stress reduction helps prevent cancer from returning, this is a hot topic. A tool like the PEPI score that can reduce treatment-induced stress is a step in the right direction.

Image by Flickr user Markhillary used under the Creative Commons Attribution license.