Past research has shown that neoadjuvant (pre-surgery) chemotherapy grants the same advantages for patient outcome as adjuvant (post-surgery) chemotherapy. Added benefits of neoadjuvant chemotherapy include complete removal of cancer in 20 per cent of patients, and a lower likelihood of infection at the site of surgery. Experts from across the world agree that neoadjuvant chemotherapy should be considered for all early stage breast cancer patients who are identified as requiring adjuvant chemotherapy.

The current study shows that the proportion of patients receiving neoadjuvant chemotherapy in Australia is slowly increasing (from 3 per cent in 2011 to 7 per cent in 2016), but still lower than the proportion receiving the treatment in other countries and lower than the 20 per cent of patients who would likely benefit from the treatment.

The use of neoadjuvant chemotherapy was more common among those with younger patient age, larger tumour size, higher tumour grade, HER2 positive breast cancers (HER2 is a protein which promotes growth of cancer cells) and triple negative breast cancers (i.e. negative for all three hormonal receptor tests, therefore, will not respond to hormonal therapy).

Potential reasons suggested for not treating a patient with neoadjuvant chemotherapy include waiting for information on the severity of the cancer gathered during surgery to individualise adjuvant treatment; strength and health concerns in elderly patients; and a fear that if the neoadjuvant treatment is not successful, the cancer could progress, and the possibility of surgical treatment be lost.

Previous research indicated that cancer progression is only a small possibility (3 per cent) in these situations. Further research into which patients would be unlikely to benefit from neoadjuvant chemotherapy will allow surgeons to better assess who should receive this treatment, leading to an increase in its use for relevant cases.

This paper concludes that neoadjuvant chemotherapy is being underused in Australia. Efforts to increase usage should include:

  • improvements in education around neoadjuvant treatment
  • encouraging subspecialisation in breast surgery
  • more research into which patients would be unlikely to benefit.