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BREAST CANCER CELLS IN THE BLOOD PREDICT HIGH RISK OF RECURRENCE
During my time in the lab, as a research fellow at the John Wayne Cancer Institute, I completed several research studies that revealed a powerful link between the presence of tiny numbers of cancer cells floating in the blood and overall survival in patients without any evidence of recurrent cancer by standard laboratory and radiographic tests. In these research studies, we used a powerful test, reverse transcriptase-polymerase chain reaction (RT-PCR) to detect fragments of genetic material from otherwise undetectable cancer cells in the blood of patients with a prior history of cancer. (RT-PCR, which can detect the presence of a single tumor cell floating amongst more than a million normal blood cells, is a powerful tool for detecting trace numbers of cancer cells present in the blood, bone marrow, lymph nodes, and other tissues of the body.)
A newly published RT-PCR research study appears in the current issue of the British Journal of Cancer. In this study, the blood of 82 early-stage breast cancer patients was tested for occult breast cancer cells using RT-PCR. Additionally, 16 patients with advanced breast cancer and 45 patient volunteers without breast cancer were used as “control groups.” All of these patient volunteers were then followed for an average of 51 months.
Among the women with very early breast cancer, 20 percent were found to have occult breast cancer cells lurking in their blood. By comparison, 81 percent of the women with late-stage breast cancer were found to have breast cancer cells circulating in their blood. (None of the healthy volunteers were found to have genetic evidence of circulating breast cancer cells in their blood.)
In this study, as with the findings of my own research in this area, the presence of rare circulating cancer cells in the blood of even patients with early-stage breast cancer was a powerful predictor of future breast cancer recurrence. Among these early-stage breast cancer patients, a positive RT-PCR test of the blood was associated with more than 5 times the risk of breast cancer recurrence (a more than 500 percent increase in recurrence risk) when compared to the early-stage breast cancer patients who did not have any detectable tumor cells circulating in their blood.
As with my own research, and the research of other cancer scientists, this newly published breast cancer research study confirms that the presence of trace numbers of cancer cells in the blood, even in patients with very early breast cancer, is highly predictive of future breast cancer recurrence. This is an important finding, and for several reasons. First of all, the detection of even tiny numbers of circulating tumor cells in the blood of early-stage breast cancer patients indicates a much worse prognosis for such patients, even when all of our standard laboratory and x-ray tests do not reveal any evidence of persistent or recurrent cancer in these same patients. Secondly, “ultra-staging” cancer patients with RT-PCR may be able to help us to identify early-stage cancer patients who might benefit from more aggressive treatment than patients who have no detectable tumor cells circulating in their blood.
Based upon the findings of this study, and those of other similar research studies (including my own), RT-PCR has the potential to become a very powerful clinical tool to help us to more accurately stage patients with early-stage cancers, and to individualize and personalize cancer treatment based upon this so-called “molecular” approach to cancer diagnosis and treatment.
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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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