Documents
Response
Letter to Plain Dealer Article
May
13, 2005
Dr.
Derek Raghavan
Department
of Hematology and Medical Oncology
The
Cleveland Clinic Foundation
9500
Euclid Avenue Desk 435
Cleveland,
Ohio 44114
Dear
Dr. Raghavan:
Re:
Front page article Cleveland Plain Dealer “Progress made
on breast cancer”
I
was shocked at the front page article, “Progress made on
breast cancer,” justifying the use of chemotherapy and hormone
treatment in prolonging the lives of women with early stage breast
cancer., This story is being spread all over the media.
I
wrote the following as a. letter to the Editor. Doug Clifton is
my neighbor in Bratenahl. Although it may not be published, the
Plain Dealer is aware of my concerns.
“I
attended the 8th Annual Moll Pavilion Cancer Symposium put on
by the Cleveland Clinic Cancer Center at Fairview Hospital on
April 13 and heard a presentation opposite to the referenced article.
There
I heard a presentation by Victor G. Vogel, MD, MHS FACP, Professor
of Medicine and Epidemiology, University of Pittsburgh School
of Medicine, University of Pittsburgh Cancer Institute, Magee-Womens
Hospital on “Multigene Assay and Breast Cancer Recurrence.”
Briefly,
Dr. Vogel began his presentation with the premise that with chemotherapy
treatment for node-negative, ER+ disease, many women are offered
chemotherapy, knowing that few benefit; guidelines assume all
patients benefit equally; and some patients are under-treated,
while many others are over-treated.
He
showed that high risk patients benefit from chemotherapy while
low risk patients benefit from local therapy and hormonal therapy.
In
layman’s terms, low risk breast cancer patients with negative
nodes do not benefit much as a group from chemotherapy, but do
benefit from such drugs as Tamoxifin which is hormonal therapy.
Conversely those patients with high-risk cancer benefit from chemotherapy
but do not benefit from hormonal therapy.
The
problem is, how do you predict which patients with low grade breast
cancer will be helped by chemotherapy. Because of this unknown,
all patients more and more are being offered adjuvant therapy.
We should not underestimate the toxicity of this drug when it
is weighed against the possibility that it will not extend the
lives of most of these patients.
Well,
there is now a test that costs approximately $3,500 which will
predict which breast cancer patients with low-grade cancer will
benefit from adjuvant therapy and which will not.
If
this test is used for everyone, it will mean that thousands of
women currently subjected to chemotherapy, will not need it. They
will be saved from a toxic treatment which can have long-term
effects as well as saving them from needless pain and suffering.
Secondly, millions of dollars will be saved in drug and medical
expenses.
If
I were a physician, I would be very confused after reading the
newspaper. As a cancer survivor, I am alarmed.
As
a non-medical professional but as a member of the general public,
and as a cancer survivor, I am very disheartened and disappointed.
What does one believe even if you are a physician?”
Dr.
Raghavan, I believe that now you understand my concerns. This
information disseminated all over the media and on front pages
nationwide to the public may apply more pressure to physicians
to prescribe adjuvant therapy where it may not be warranted.
I
would appreciate your comments on my apprehensions.
Sincerely,
Helen
Moss
Cc:
Dr. Toby Cosgrove
