BREAST CANCER – To Chemo or Not To Chemo?

Recent studies have shown that many women who have been diagnosed with the most common form of breast cancer may not actually need chemotherapy.

Thousands of women with the most common form of early breast cancer may be spared chemotherapy under a new “precision medicine” approach, according to a landmark study.

Researchers estimate that more than 123,000 women in the US and 23,000 women in the UK are diagnosed with the particular form of the disease each year. With the new treatment protocols, less than a third of them would need chemotherapy.

This is great news given that chemotherapy itself can cause awful side effects. But chemotherapy is not being given the boot all together. There are still many other forms of breast cancer that will respond to chemo, and it is still a life-saving treatment for those that really need it.

Breast cancer is the most common cancer in women worldwide. This study looked at women with early hormone-receptor-positive, HER2-negative, axillary-node-negative breast cancer, which accounts for about half of all cases.

For most women, standard care involves chemotherapy and endocrine therapy, in part because of chemotherapy’s proportionally greater benefits for young women.

Nausea, vomiting, hair loss and fatigue, and in rare cases leukemia can accompany chemotherapy. Researchers were able to separate, through genetic testing, women more likely to have recurrent cancer, which could potentially spare thousands from the treatment.

Researchers looked at more than 10,000 women aged 18 to 75. The test assigned women a score from 0 to 100 based on the likelihood cancer would return within 10 years.

Researchers already knew women with scores of 0-10 did not benefit from chemotherapy – about 17% of the women in the study. Conversely, women with a risk score of 26 or more (14% of the study) did benefit from chemotherapy.

The study’s aim was to assess the majority of women in the middle, with a score of 11-25. Of the 10,273 women tested, 6,711 (69%) had a score of 11-25. They were randomly assigned to receive endocrine therapy alone, or a combination of endocrine and chemotherapy. Researchers concluded that, depending on a patient’s age, women who received only endocrine therapy did not fare worse than those who were also treated with chemotherapy.

It means women over 50 with this type of cancer and a score of 0-25 do not need chemotherapy; women younger than 50 with a score of 0-15 can also avoid the difficult   treatment.


The Best Treatment is Prevention

Regardless of the treatment that you may need if you should be diagnosed with breast cancer, early diagnosis always improves that outcome, and the best way person to detect this is yourself.

The most common signs of breast cancer are a lump in the breast; abnormal thickening of the breast; or a change in the shape or color of the breast. Finding a lump or change in your breast does not necessarily mean you have breast cancer. Additional changes that may also be signs of breast cancer include:

  • Any new, hard lump or thickening in any part of the breast
  • Change in breast size or shape
  • Dimpling or puckering of the skin
  • Swelling, redness or warmth that does not go away
  • Pain in one spot that does not vary with your monthly cycle
  • Pulling in of the nipple
  • Nipple discharge that starts suddenly and appears only in one breast
  • An itchy, sore or scaling area on one nipple


Breast Self Examination (BSE)

Prevention and early diagnosis is the best tactic in combating this fatal disease. Breast self examination (BSE) is the best way to detect abnormality of the breast in the early stages.


(Full instruction on BSE is available on the Bali Advertiser Website on a previous breast cancer article).

  • BSE should be done at the same time each month.
  • The best time is a couple of days after the end of your period, when your breasts are less likely to be tender or lumpy from hormone effects.
  • If you no longer have periods, choose a day you can remember e.g. the first Monday of each month.

Remember: Only you can do Breast Self-Examination – no one knows your body better than you do. Always consult your doctor if you are concerned about any breast changes. He or she can conduct a thorough manual breast examination, and may recommend a mammogram (breast x-rays), and / or ultrasonic examination. The combination of the methods you use will depend on your age, your medical history and your doctor’s advice.



Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her Community Health Care office in Sanur.


Kim is happy to discuss any health concerns that you have and may be contacted via email at, or office phone 085105-775666 or Bali


Copyright © 2018 Kim Patra

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