AML/MDS after Breast Cancer
This is a serious entry about a very serious problem. We have long known that one possible (albeit blessedly rare) long term consequence of certain chemotherapy drugs can be AML (acute myeloid leukemia) or MDS (myelodysplastic syndrome). A recent study by the US Oncology Network reported no increased risk for women in the first three years after finishing chemotherapy, BUT a four fold increase in risk over time for women who had received one of the anthracycline-containing drugs. For breast cancer regimens, this basically means that the risk may arise from cytoxan or Adriamycin. This worry brings us back to a central issue: balancing risk vs benefit of any particular treatment and is a major reason why the advances in determining who really needs chemotherapy (think Oncotype DX test) are so welcome. At the time of breast cancer diagnosis, the focus needs to be on trying to cure that disease, not on undue worry about something that might happen a decade later. However, the risks are real and reminders of how powerful are these drugs.
Over more than thirty years, I have known three women who developed one of these diseases post treatment. Two had breast cancer and one had been treated years earlier for Hodgkins' Disease. Both women who had been treated for breast cancer underwent bone marrow transplants. One is doing just fine ten years or so after that transplant; the second died. The women who had previously had HD had years of sporadic treatment for leukemia, and also eventually died. These numbers are small, and the intent is surely not to scare anyone. We all made the best decisions for ourselves that we could. Knowing these small risks, I absolutely opted for chemotherapy both times I was diagnosed with breast cancer.
Here is the beginning of an article from MedScape and then a link:
Study Sparks Debate Over Risk for AML/MDS After Chemo
September 19, 2012 - The overall risk for acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) is not increased in the first 3 years after breast cancer chemotherapy, researchers from the US Oncology Network have concluded after studying more than 20,000 patients.
However, of the 41% of chemotherapy patients who received an anthracycline-containing regimen, there was an almost 4-fold risk for AML/MDS, lead investigator Neelima Denduluri, MD, reported at the 2012 Breast Cancer Symposium being held in San Francisco, California.
Overall, the findings are reassuring, in that "the rates of AML and MDS were no different in the women who received chemo" and those who did not, said Dr. Denduluri, a medical oncologist and hematologist from Virginia Cancer Specialists in Arlington, in an interview with Medscape Medical News.
But Otis Brawley, MD, chief medical officer of the American Cancer Society, challenged that interpretation of the data.
"There is a serious need for a clinical trial here," he told Medscape Medical News. "I hear well-meaning clinicians, who do not normally design trials, not understanding how to interpret trial results. This happens a lot," said Dr. Brawley, who is professor of hematology, oncology, and medicine at the Emory University School of Medicine and chief of hematology and oncology services at the Georgia Cancer Coalition Center of Excellence at Grady Memorial Hospital, both in Atlanta.
The time period was insufficient, Dr. Brawley said. "The study followed people for 2 to 3 years and failed to find what is expected to happen at 5 to 10 years.... The authors conclude they find no evidence that chemotherapy is associated with cancer after looking for too short a time," he explained