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Does chemotherapy for breast cancer always make sense?
In previous practice in the treatment of breast cancer, surgical removal of a breast tumor was followed by chemotherapy in order to kill any cancer cells that may still be present. However, according to the German Cancer Society, cancer therapy has changed fundamentally due to the new possibility of genetically analyzing tumors. While in the past all patients received the same treatment, today the focus is increasingly on the individual patient with his specific tumor properties. More and more doctors are opting for a new gene therapy in order to possibly save women the stressful treatment.
The biomarker tests analyze the concentration of certain proteins or different genes, the properties of which are intended to provide information about the course of the disease. The result should help the doctor to assess which women need adjuvant chemotherapy and which do not, depending on how aggressively the tumor is classified. For example, the test examines whether there are certain mutations in which specific drugs are particularly effective.
Biomarker tests for breast cancer are controversial
According to the German Cancer Society, prognosis tests for breast cancer patients through media and advertising materials are well known. Last but not least, there is also commercial interest behind the strong presence. In order for the tests to be included in the standard repertoire of a treatment, they would have to be able to demonstrate their benefits even more scientifically. The German Cancer Society has created a new guideline that recommends the genetic test for cancer in selected situations. If breast cancer is detected at an early stage at which no clear recommendation for or against chemotherapy after surgery can be given, a biomarker test can help in decision-making. After all, that is the case for around 20,000 patients every year.
IQWiG experts warn against the reliability of the test
The experts at the Institute for Quality and Efficiency in Health Care (IQWiG) in Cologne also emphasize that, according to the current state of research, the genetic test for cancer does not provide any clear insight into whether chemotherapy should be used or not. The follow-up period of the cancer at five years is too short, since relapses and metastases often only occur after ten to 15 years in breast cancer. A team of authors at IQWiG recently criticized the American Society of Clinical Oncology (ASCO). ASCO published a study that concluded that the MammaPrint biomarker test could make it easier for a certain group of patients to decide which therapy to use. The IQWiG authors contradict the results in a letter to the editor. Although the study provides valuable insights into the biomarker tests, the findings of the ASCO authors are wrong.
Who pays for the expensive biomarker tests?
According to the German Cancer Society, health insurance companies are not obliged to bear the costs of breast cancer prognosis tests. It would be the task of the Federal Joint Committee to include such a test. However, individual health insurance companies would already bear the costs in the context of studies. Ultimately, every breast cancer patient has to decide whether to use chemotherapy or trust (and pay for) a biomarker test. (fp)