Why we need a rethink about chemo
t is a bit odd, on reflection, that the “biggest breakthrough in cancer treatment” in the last 20 years, as reported last week, was not the discovery of some new effective treatment – rather, that more than two thirds of women with early breast cancer do not benefit from chemotherapy and thus should be spared the gruelling ordeal.
The relevant figures are certainly startling. Five years after diagnosis, 98per cent of those at low risk of recurrence, as determined by a genetic test, were alive and well taking just hormonal therapy (such as Tamoxifen), compared to 98.1per cent of those who had also received chemotherapy.
Put another way, the quality of life of tens of thousands of women in the past 30 years has been seriously compromised not through being diagnosed as having breast cancer, but by the toxic effects of unnecessary chemotherapy.
There is, as yet, no comparable genetic test for other types of early cancer where chemotherapy may be similarly inappropriate. There is, however, evidence to this effect from elsewhere. Writing in the European Journal of Cancer in 2016, Dr Anne Breugom of the University of Leiden found no correlation between the marked variation in the routine use of adjuvant chemotherapy in Denmark, Sweden, England, Belgium etc, for early-stage tumours of the colon and subsequent rates of recurrence or overall survival. This clearly merits further investigation.
Heart of the issue
The very substantial benefits of prescribing blood-thinning drugs such as warfarin for those with atrial fibrillation (AF) – 45 cases of stroke prevented for every thousand patients treated – extends to those whose heart rhythm irregularity is intermittent.
By contrast, the prevailing view concerning those whose AF was only temporary and appears to have completely resolved holds that it is probably reasonable to stop taking them after a year or so. But is this correct, and how can one tell? The singular virtue of a truly national health service is that the medical records of tens of thousands of patients can be integrated into a single massive database, capable of resolving this type of question.
The findings, reported in the British Medical Journal, contradict the current advice. Whereas those whose AF has resolved do indeed, as might be expected, have a lower risk of stroke, that risk is still higher than those whose heart rhythm has always been normal. “Those with resolved atrial fibrillation may benefit from taking anticoagulants,” observes Professor Tom Marshall of the University of Birmingham.
Pills aren’t forever
My thanks to all who have written appreciatively of my new book, Too Many Pills, and contributed their own personal stories. They include a woman in her early 80s taking just the single blood pressure-lowering drug felodipine for the past 10 years that keeps her upper (systolic) reading between 110 and 130. Not much to go wrong here, one might suppose, as she has been taking it without problems for so long.
Still, over the past year, she has become noticeably more short of breath when out shopping, with “endless muscles aches”. This was, she thought, probably due to her “getting on”. But reading of my book in this column, she wondered whether the felodipine might be responsible, and arranged to see her family doctor. The week before her appointment, she decided to experiment by discontinuing it, “and almost immediately felt so much better in myself ”. Her blood pressure has risen a bit, but is still a respectable systolic of 145.
“We have agreed to continue without the felodopine to see what happens,” she writes. A reminder that even previously well-tolerated drugs can cause problems.
The quality of life of tens of thousands of women has been seriously compromised
Apology: I’d like to say sorry to all who were unable to access the website mentioned in the column for families whose daughters have been adversely affected by the cervical cancer jab (HPV vaccine). It should have read timeforaction.org. uk.
To order Too Many Pills (Little, Brown, £13.99), for £10.99 plus p&p, call 0844 871 1514 or visit books. telegraph.co.uk