A New Era in Breast Cancer Care: When Less Treatment Can Be the Right Treatment
- 8 hours ago
- 7 min read
Article by Dr. Donald Greig
I recently read a fascinating report about a large international study that may change the way we treat many women with breast cancer.
The headline was striking: A genetic test could allow thousands of women to safely avoid chemotherapy.
For decades, chemotherapy has been one of the central pillars of breast cancer treatment. It is powerful, and in many cases lifesaving. But it is also one of the most physically demanding treatments in medicine.
Now, new research suggests that for a substantial group of women, chemotherapy may not always be necessary.
The Optima Trial: Personalising Treatment
The findings come from the Optima trial, presented at the American Society of Clinical Oncology (ASCO) annual meeting.
Researchers studied more than 4,400 patients with early-stage, hormone-sensitive breast cancer that had spread to the lymph nodes — a group traditionally offered chemotherapy to reduce the risk of recurrence.
The trial evaluated a genetic test called Prosigna, which analyses the activity of genes involved in breast cancer growth using tissue removed during surgery.
The idea is simple but powerful:
Instead of treating everyone the same, can we identify which cancers are biologically aggressive - and which are not?
What Is Hormone-Sensitive Breast Cancer?
Approximately 70–80% of breast cancers are hormone-sensitive (also called hormone receptor-positive).
This means the cancer cells grow in response to hormones such as oestrogen and/or progesterone.
The important implications are:
These cancers often respond well to hormone-blocking therapy (such as tamoxifen or aromatase inhibitors).
They tend to behave differently from more aggressive subtypes such as HER2-positive or triple-negative cancers.
Treatment decisions are often more nuanced, because hormone therapy alone may be highly effective.
Understanding the biology of the cancer helps guide how intensive treatment needs to be.
The Results of the Study
The findings were striking.
68% of patients had a low Prosigna score.
Among these women, those who received hormone therapy alone (without chemotherapy) had outcomes almost identical to those who received both chemotherapy and hormone therapy.
At five years:
94.8% of women receiving standard chemotherapy plus hormone therapy were alive and cancer-free.
93.6% of women receiving hormone therapy alone were also alive and cancer-free.
For women with a low Prosigna score, chemotherapy did not significantly improve outcomes.
This is strong evidence that many women can safely avoid the additional burden of chemotherapy.
Why This Matters
Chemotherapy is highly effective at destroying rapidly dividing cancer cells. But it also affects healthy, fast-growing cells.
Common side-effects include:
Profound fatigue
Nausea and vomiting
Hair loss
Altered taste and appetite
Increased infection risk
Avoiding chemotherapy where it does not add meaningful benefit can significantly improve quality of life during treatment.
As one patient described learning she could safely avoid chemotherapy:“It felt like Christmas.”
Genetic Tumour Testing vs BRCA Testing — What’s the Difference?
Patients often understandably confuse these two.
They are very different tests.
Prosigna (and similar tests):
Analyse the activity of genes within the tumour itself.
Help predict how aggressive the cancer is.
Guide decisions about chemotherapy.
Do not assess inherited cancer risk.
BRCA testing:
Looks at inherited gene mutations in blood or saliva.
Identifies increased lifetime risk of breast and ovarian cancer.
May influence preventive surgery decisions.
Is about risk of developing cancer, not how to treat an existing tumour.
One test guides treatment. The other assesses inherited risk.
Both are important — but for different reasons.
Precision Medicine in Action
Approximately two million people worldwide are diagnosed each year with hormone-sensitive breast cancer.
If two-thirds of these patients have low genomic risk scores, millions could potentially benefit from more tailored treatment decisions.
This represents something very important in modern medicine:
Not more treatment.
Not less treatment.
The right treatment.
What This Means for My Patients
In my own practice, breast care represents a significant part of what we do.
Early detection remains critical. Screening identifies cancers at a stage where treatment is more effective and often less aggressive.
What is changing - and encouraging - is what happens next.
We are moving away from a “one-size-fits-all” approach and toward biologically informed, individualised care.
Not every breast cancer behaves the same way.
Not every patient requires the same intensity of treatment.
Genomic testing is helping us refine those decisions.
A Continuing Theme: Balancing Benefit and Harm
In a recent newsletter, I wrote about the thoughtful use of medical radiation — acknowledging that while imaging saves lives, it should always be used with care and proportionality.
This new research reflects the same principle.
Just as we aim to avoid unnecessary radiation exposure, we must also avoid unnecessary treatment.
Chemotherapy is powerful and lifesaving when needed. But when biology tells us that hormone therapy alone is sufficient, sparing patients additional toxicity represents real progress.
Good medicine is not about doing more.
It is about doing what genuinely improves outcomes.
Maximise benefit.
Minimise harm.
Personalise care.
That is the direction modern oncology is moving — and it is encouraging to see strong evidence guiding that shift.
A Broader Reflection
This study reflects a principle I often return to:
Good medicine is not about doing more.
It is about doing what genuinely improves outcomes.
We are entering an era where treatments are increasingly guided not just by what we can do, but by what is biologically necessary.
That is real progress.
Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.
Genetic test could offer breast cancer patients chance to skip chemo
Article by Poppy Koronka
Millions of women with breast cancer could avoid chemotherapy thanks to a ground-breaking genetic test, scientists have said.
It could benefit up to 5,000 women being treated within the NHS in England each year and could help to provide better, more tailored treatments for millions worldwide.
Chemotherapy is one of the hardest-hitting treatments for cancer in terms of side-effects, and avoiding it could improve the quality of life during treatment for many patients.
While chemotherapy is frequently offered to patients with early-stage breast cancer that has spread to the lymph nodes to prevent it from returning, it may not significantly improve the prognosis of women with hormone-sensitive breast cancer.
In the Optima trial, the results of which were presented at the American Society of Clinical Oncology’s (ASCO) annual meeting in Chicago, scientists from University College London evaluated a test to find out which patients could safely forgo chemotherapy and its side-effects without having a worse prognosis.
The Prosigna test measures the activity of genes involved in breast cancer growth by testing tissue removed during surgery. Those with a low score on this test may not benefit from chemotherapy.
The 4,400 patients were split into two groups. Half receiving chemotherapy regardless of their test result, as is standard, and half had their treatment directed by their test score.
More than two thirds of the patients — 68 per cent — had a low score of below 60.
The results showed that 94.8 per cent of patients who received chemotherapy and hormone therapy, the standard current treatment, were alive and cancer-free five years after the trial.
Meanwhile 93.6 per cent of those who had hormone therapy but no chemotherapy were also alive and cancer-free five years later, meaning that for women with a low Prosigna score, chemotherapy did not significantly improve their outcome.
While chemotherapy is highly effective at destroying rapidly dividing cancer cells, it also inadvertently affects healthy, fast-growing cells in the body, leading to a range of side-effects. Patients commonly experience profound fatigue, nausea, vomiting, a loss of appetite or altered taste, and hair loss.
Some two million people receive a diagnosis of hormone-sensitive breast cancer worldwide each year, meaning that if two thirds of them have low Prosigna scores, millions could be set to benefit.
The research followed the patients who were over the age of 40 across the UK, Norway, Sweden, Australia, New Zealand and Thailand. Some men were included, but there were not enough taking part to statistically analyse. Both pre and post-menopausal women took part in the research.
Iain MacPherson, co-chief investigator and professor of breast oncology at the University of Glasgow, said: “Optima provides robust, practice-changing evidence that we can safely reduce the use of chemotherapy for many patients with hormone-sensitive breast cancer.
“These findings represent a major step forward in delivering more personalised, precise care, ensuring that treatment decisions are driven by what will genuinely improve outcomes for patients, while avoiding unnecessary toxicity. The potential impact for both patients and health services is substantial.”
Karen Bonham, 64, from Cardiff, described the news that she could forgo chemotherapy as “like Christmas”. She was diagnosed with breast cancer after attending a routine screening in 2017.
She enrolled in the Optima trial the same year after discussing how much she was dreading chemotherapy with her oncologist and undergoing a left mastectomy. She was a few days away from starting treatment when she received her test result and had already cut her hair short when she found out she could avoid the treatment.
“Cancer diagnosis and treatment can be shocking. It certainly propels you into a world of uncertainty. Life priorities realign — you simply want to survive,” Bonham, a mother of two, said.
While walking on a local beach, Bonham received a phone call from her hospital telling her she did not require chemotherapy. “How to describe the initial feeling? Immense relief? Like Christmas? Certainly a mixture of the two,” she said.
Instead of chemotherapy, Bonham went on to receive radiotherapy and hormone therapy, completing eight years of active treatment.
Almost nine years on from her diagnosis, Bonham says she does not feel defined by cancer and has returned to normal family life. She remains active, enjoying walking and yoga, and says taking part in the Optima trial “helped decision making to allow me to receive targeted, appropriate treatment more quickly and has enabled my positive health outcome.”
Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.
Comments