In 2019, international guidelines were introduced that recommend the use of systemic therapies (types of therapies that spread through the whole body to treat the tumour cells) before surgery for some breast cancers. The recommendation was for stage 2 or 3 breast cancer (tumour of at least 1cm with spread to lymph nodes) that is either triple negative (tumour growth not affected by female hormones or HER2 protein) or HER2 positive (growth of tumour affected by large amount of HER2 protein in cancer cells).
Systemic therapy before surgery can:
- Make tumours smaller, which means less need for invasive surgery and women can keep most of breast.
- Avoid need for removal of lymph nodes in the armpit and any complications of this surgery.
- Provide time to test for gene mutation to help in decisions about type of surgery recommended.
Research using data from the BreastSurgANZ Quality Audit (BQA), covering 2009 to 2019, showed the use of chemotherapy (one form of systemic therapy) before surgery is increasing each year from very few to 32% of triple negative breast cancer patients and 35% of HER2 positive patients in 2019. It also showed that 30% of HER2 positive tumours were being treated with anti-HER2 immunotherapy (another form of systemic treatment) prior to surgery.
BQA Key Performance Indicators were updated in 2023, with a target of at least 70% of patients who are less than 70 years of age being recommended for chemotherapy before surgery if they have a tumour at least 2cm and either triple negative or HER2 positive. Looking at data from 2018 to July 2023 shows that surgeons were recommending chemotherapy for 39% of these cancers before the KPI threshold was set.
The authors of this research believe that surgeons should strive to identify patients who would benefit from systemic therapies before or after surgery.
Reference:
Duffield JA, Blanch AJ, Esterman A, Bochner MA. The use of neoadjuvant systemic therapies in breast cancer in Australia and New Zealand: Breast Surgeons of Australia and New Zealand quality audit. ANZ J Surg. 2023 Apr;93(4):889-895. doi: 10.1111/ans.18367. Epub 2023 Mar 13. PMID: 36912120.