How much is too much?

Anew study has shown that many women who receive chemotherapy for a specific type of breast cancer do not need it. The type of tumour involved, called hormone-receptorpositive, accounts for roughly half of all breast cancers.

Researchers recruited women from across North America, including some receiving treatment at the B.C. Cancer Clinic in Vancouver. The results showed that as long as this type of tumour has not advanced to other parts of the body, chemotherapy might not be required.

Thanks to mammography, which detects tumours at an early stage, the vast majority of women diagnosed with breast cancer today do not have advanced tumours. That increases the impact of this new discovery.

In days gone by, 60 per cent of women with this kind of tumour would have been given chemotherapy. In B.C., that translates into 1,200 newly diagnosed patients each year. But of those 1,200, we now know 840 do not need chemotherapy.

Surgery is still required, but after that, new medications such as Tamoxifen are sufficient to produce a successful outcome. And unlike traditional chemotherapy, which many patients dread, these new medications are easily tolerated.

This breakthrough is the latest application of what is being called personalized medicine.

Women with early-stage breast cancer have their DNA read. The test, which is government funded, shows whether patients have the right type of tumour. (A reminder: We’re talking about only one type of breast cancer. Other varieties would not benefit from this treatment.)

The new approach might also apply to other forms of cancer.

That is the good news. But there is, as always, another side to the story.

DNA testing is expensive. We don’t know the cost in Canada because it’s considered proprietary information, but in the U.S., the price per patient is $6,000 Cdn.

Last year 13,000 women, Canada-wide, were diagnosed with hormone-receptorpositive tumours. Using the American price tag, testing would have cost about $80 million.

And that is just the start. Personalized medicine will play a central role in healthcare systems of the future. Many ailments are genetically based, such as Alzheimer’s, Type 2 diabetes, Parkinson’s disease and dozens more.

It will eventually be possible to treat these conditions far more effectively using individualized gene testing. But while costs will probably decline as the procedure becomes more common, there will still be an enormous financial impact.

And that creates a dilemma. Just how much benefit to an individual patient is required to justify the costs involved?

Certainly, if the procedure might be lifesaving, that would be sufficient. But what if it merely reduces symptoms somewhat?

Financially speaking, this is perhaps the greatest challenge facing our already strained health-care system (though aging is a close second). It’s a predicament that must be solved.

— Victoria Times Colonist