Cancer
Cells in the Bone Marrow Predict for Worse Outcome in Patients
with Early Breast Cancer
According to results presented at the 2003 San Antonio Breast
Cancer Symposium, the presence of even one cancer cell in
a sample of bone marrow predicts for a worse outcome in patients
with early breast cancer.
One area of research that is currently receiving much time
and attention is the identification of specific disease or
patients characteristics that may help predict the prognostic
of a patient with cancer. It is the hope that these prognostic
factors will help to individualize treatment therapies and
ultimately improve outcomes for patients with various cancers,
including breast cancer. Results from previous studies have
indicated an association between the presence of cancer cells
in the bone marrow and a poor prognosis in breast cancer.
Bone marrow is the spongy material inside large bones, where
immature blood cells are formed. It is thought that cancer
cells found in the bone marrow indicate that cancer has spread
in the body, and may result in increased recurrence rates
and reduced survival. Physicians currently assess certain
factors of breast cancer to determine optimal therapy, such
as the spread of cancer to tissues in the breast or the rest
of the body, the spread of cancer to lymph nodes under the
arm (axillary nodes), hormone-receptor status of the cancer,
aggressiveness of the cancer and human epidermal receptor-2
(HER2) status.
Researchers from Norway recently conducted a clinical trial
to evaluate the potential clinical utility of detecting the
presence of cancer cells in the bone marrow in patients with
early breast cancer. This trial included 356 patients with
early breast cancer; the majority of whom had no spread of
cancer to axillary lymph nodes. Patients underwent initial
surgery to remove the cancer, during which a bone marrow sample
was taken (BM1) and analyzed for the presence of one or more
cancer cells. Three years following initial surgery, patients
underwent a second bone marrow sample (BM2) that was also
analyzed for the presence of one or more cancer cells. All
patients were considered cancer free according to clinical
evaluation. Approximately 2 years following BM2, the rate
of patients who had not experienced a cancer recurrence was
as follows: 93% for those with no cancer cells found on BM1
and BM2; 92.6% for patients with cancer cells on BM1, but
not on BM2; 87.9% for patients with no cancer cells found
on BM1, but cancer cells found on BM2; and 70.6% for patients
with cancer cells found in both BM1 and BM2.
The researchers concluded that bone marrow samples evaluating
for the presence of one or more cancer cells may help to provide
further indication of the prognosis of a patient, as well
as monitor disease response to therapy. Patients with cancer
cells in the bone marrow may be considered appropriate candidates
or chemotherapy, even with early stage disease. These results
lend further confirmation to results from previous studies
evaluating this issue. Patients with breast cancer may wish
to speak with their physician about the risks and benefits
of bone marrow sampling in their individual situation.
Reference:
Wiedswang G, Borgen E, Karensen R, et al. The presence of
isolated tumor cells in bone marrow three years after diagnosis
in disease free breast cancer patients predicts an unfavourable
outcome. Proceedings from the 2003 San Antonio Breast Cancer
Symposium. December 2003. Abstract #8.
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