Millions of women worldwide diagnosed with breast cancer may in the future avoid chemotherapy treatments, following the results of a major international study that examined a new genomic test that helps doctors decide which patients truly need the treatment.
Breast cancer is the most common type of cancer among women worldwide. In most cases, treatment includes surgery to remove the tumor, after which a decision is made as to whether chemotherapy is needed to reduce the risk of the disease returning in the future. For many years, doctors had to make these decisions based on various clinical characteristics, but it was not always possible to know with certainty who would derive real benefit from the treatment and who could manage without it.
Chemotherapy has a central role in the fight against cancer, but it also involves significant side effects. Many women cope during treatment with hair loss, nausea, extreme fatigue, sleep disturbances, rashes, and damage to quality of life. In certain cases, long–term consequences may also appear, including impairment of fertility, a decline in cognitive function, or early onset of menopause.
Now, researchers present results that could change the picture.
4,400 patients from all over the world
The study, called Optima, was led by researchers from the UK and included more than 4,400 patients diagnosed with new breast cancer. The participants were recruited from the UK, Norway, Sweden, Australia, New Zealand, and Thailand. The objective of the study was to examine whether a genomic test could be used to more accurately identify the risk of the disease returning, and accordingly determine whether chemotherapy is necessary.
The test examined in the study, Prosigna, analyzes the activity of 50 genes in the tumor tissue. Through the analysis, it is possible to determine the molecular subtype of the cancer and estimate the risk of the disease returning during the next ten years. This information allows doctors to make more precise treatment decisions and tailor the treatment to each patient personally.
The study focused on women aged 40 and older with hormone–receptor–positive breast cancer, the most common type of the disease, which accounts for about 80 percent of breast cancer cases worldwide. The participants were divided into two groups. In the first group, patients received the standard treatment, which included chemotherapy followed by hormone therapy.
In the second group, a genomic test was performed on the tumor, and the treatment was determined according to its results. Patients who received a high–risk score were treated with chemotherapy and hormone therapy, while patients who received a low score were treated with hormone therapy alone.
Clear results: Many women will be able to avoid chemotherapy
The results were particularly impressive. Five years after the treatment, it was found that 95 percent of the patients who received both chemotherapy and hormone therapy remained alive without a recurrence of the disease. In comparison, 94 percent of the patients with the low–risk score, who skipped chemotherapy and received hormone therapy alone, were also alive and without a recurrence of the cancer.
The meaning is that among certain low–risk women, chemotherapy provided almost no additional advantage in terms of preventing the return of the disease. If the findings are widely adopted, many women will be able to avoid complex and difficult treatment without harming their chances of recovery.
According to the researchers, this is a significant step on the way to personalized medicine. Instead of relying only on traditional characteristics of the tumor, genetic and molecular information can be used to better understand the behavior of the disease and choose the most suitable treatment for each patient.
Beyond the benefit for the patients themselves, the findings may also have broad economic and health significance. Reducing the use of chemotherapy in cases where it is not necessary may reduce the burden on healthcare systems, save resources, and improve the quality of life for many patients.
The researchers emphasize that this is not about eliminating chemotherapy, but rather about more accurately identifying the women who truly need it. For patients with a high risk of the disease returning, the treatment continues to be an important and significant part of the fight against cancer. However, for others, the new test may make it possible to avoid aggressive treatment and suffice with hormone therapy alone.
The results of the study are expected to be at the center of discussions at the annual conference of the American Society of Clinical Oncology, one of the most important conferences in the world in the field of cancer. If adopted in international treatment guidelines, they may change the way many breast cancer patients make decisions about their treatment in the coming years.
The test is available in Israel: Who can receive it for free?
The test used in the study, Prosigna, is also available in Israel, except that its price, without insurance coverage, is particularly high – and it ranges between 3,000 to 4,000 dollars, without insurance coverage.
However, many breast cancer patients can receive the test free of charge, according to the following rules:
• Health funds participation: For women diagnosed with early–stage hormonal breast cancer (estrogen–receptor–positive, HER2–negative types), the test may be covered through the health basket or supplementary insurance (such as "Shaban"), according to the recommendation of the oncologist.
• Personalization of treatment: The test classifies the type of tumor (such as Luminal A or Luminal B) and helps doctors decide whether there is a need for chemotherapy treatment, or whether it can be safely avoided.
Performance of the test: The test is performed in authorized laboratories in Israel (such as L.E.M. laboratories or public hospitals such as Hadassah Ein Kerem), and is ordered directly by the treating oncologist.
It is recommended to contact the treating oncologist or the service center of the health fund to check eligibility and receive an accurate price quote according to the patient's medical insurance.