I am up late tonight (several hours ahead of U.S. time), just heard the news that Elizabeth Edwards has been diagnosed with a recurrence of her breast cancer and wanted to let ScienceBlogs readers know what information we medical oncologists look for in this situation. Reading the news reports about her relapse is an exercise in futility; even if her doctors provided all of the details of her tumor most (if not all) reporters would be unable to translate it into anything comprehensible.
This is one of my gripes about medical news reporting – no reporters can understand what the data actually mean and no reporters have any interest in finding out. Thus, readers are left with half-truths and erroneous conclusions that serve only to amplify the chaos around such a serious event.
If Ms. Edwards was my patient, here are the details that I would have to know in order to care for her properly:
1. Age (older patients typically harbor more indolent tumors).
2. Menopausal status (pre-menopausal patients usually have more aggressive tumors).
3. Size of tumor (the greater the size the lower the cure rate).
4. Presence of lymph nodes (one is bad; greater than four is worse).
5. Estrogen and progestrone receptor status (agressive tumors are more likely to be ER and PR negative, and such tumors can often be treated with oral medications at the time of relapse, rather than chemotherapy).
6. Her-2 status (only 20-25% of women have Her-2 receptors on their tumors, which enables the tumor to grow and metastasize easily. Such tumors are receptive to the monoclonal antibody trastuzumab, which prolongs survival when given with chemotherapy).
7. Type of adjuvant chemotherapy previously given (we docs usually don’t recommend that a patient receive the same drugs twice, at least not at the start).
8. Length of time from original diagnosis to relapse (this actually was commented on in a news report – the shorter the time between the two, the more aggressive the tumor is, typically).
9. Site of relapse (disease in visceral organs, such as liver and lungs portends a worse prognosis compared to relapse in skin or lymph nodes).
10. The general health of the patient (those with heart failure, lung disease, kidney failure, dementia and other major health problems have fewer options for treatment compared with fit patients).
You can see there are many issues to take into consideration when sitting down to counsel a patient who has just had her breast cancer relapse. No two patients are exactly alike. I hope that we all take this into consideration when reading about Ms. Edwards’ situation – jumping to horrific conclusions based on inaccurate news reports does her a disservice. My thoughts and prayers go out to her and her family.