Caring Currents

Early Stage Breast Cancer Alert

Last updated: Nov 04, 2009

Picture 2

If you or a woman you know has early stage breast cancer that's HER2-positive, she needs to know about some new research published yesterday in the Journal of Clinical Oncology.

An early stage tumor that's as tiny as one centimeter or smaller still has a high risk of deadly recurrence if it's HER2-positive, new data show.

Researchers from the M.D. Anderson Cancer Center reviewed recurrence data on breast cancer patients whose tumors were one centimeter or smaller -- typically considered to present a very low recurrence risk. (See size chart; one cm is about the size of a black-eyed pea.) What they found was that if a woman's tumor, no matter how tiny, was HER2-positive, her 5-year recurrence rate was 23 percent -- almost one in four.

Led by Ana Gonzalez-Angulo, MD, the researchers analyzed the center's breast cancer research database, which contained data on 965 women whose tumors were less than one centimeter when diagnosed, and who did not receive treatment with Herceptin.

The reason this is so important is that it suggests a big change in treatment protocol is in order. Based on this study, which was then confirmed by a second, European study, it seems clear that women with early stage HER2-positive tumors need to be treated with Herceptin, no matter how small their tumors.

Between 15 and 20 percent of breast tumors test positive for the HER2 growth protein, which is basically a growth factor that makes cancer more aggressive. Herceptin, the brand name for trastuzumab, has become a life-saving drug for women with HER2-positive breast cancer; it latches onto the HER2 proteins and inhibits their growth, stopping them from fueling tumor growth.

In the past, the "cut-off" for Herceptin has been six centimeters; current treatment guidelines for women whose tumors are five centimeters or smaller call for only surgery and radiation. And for women whose tumors are six to ten centimeters, the guidelines say doctors should "discuss" the option of Herceptin treatment.

M.D. Anderson doctors now say it's time to change the guidelines - and fast. "The risk of recurrence was much higher than we suspected," says oncologist Jennifer Litton, another author. "Herceptin alone or combined with chemotherapy should be strongly considered as adjuvant therapy" (meaning either before or after surgery) even in patients whose tumors are "miniscule."

Honestly, after reading the M.D. Anderson research, I would want to make sure any woman whose tumor tested positive for HER2 received treatment with Herceptin, regardless of tumor size.

As for women who were diagnosed with a HER2-positive tumor in the past and didn't receive Herceptin, that's a moving target. The study didn't include them, and doctors have in the past been unwilling to prescribe Herceptin therapy separately because it hasn't been studied.

But if it were me or someone I loved, I'd talk to the doctor about whether Herceptin even post-treatment could help minimize risk of recurrence. Discussions on this topic are raging on medical websites, and it's certainly worth asking.

So: Herceptin even for very small early stage tumors -- Let's spread the word.