▲ Breast cancer is one of the leading killers of women in Hong Kong. Genetic testing can help evaluate the effectiveness of chemotherapy and help patients create more appropriate treatment plans. (iStock image)
When talking about cancer treatment, chemotherapy and radiotherapy are the first things that come to mind. However, it turns out that chemotherapy does not always have a significant effect on every patient. Some studies have found that less than 2 out of 10 early-stage breast cancer patients benefit from it. Chemotherapy is expensive and has many side effects. How can you determine if you are suitable for it before starting treatment to avoid unnecessary strain on your body? That’s where specialists come in.
Only 2 out of 10 early-stage patients benefit from chemotherapy
The Hong Kong Breast Cancer Foundation commissioned an organization to conduct a “Breast Cancer Awareness and Treatment Opinion Survey” in June this year, interviewing 530 people through an online questionnaire. The results show that over 70% of adults believe that chemotherapy and radiotherapy are necessary once breast cancer is diagnosed. However, 9 out of 10 adults are worried about the side effects of treatment, and more than 60% of respondents said they would prefer alternatives to chemotherapy if available. This indicates the public’s limited knowledge about breast cancer treatment options and their fear of the negative effects of chemotherapy.
According to data from the Hong Kong Breast Cancer Database, the overall cost of treatment for breast cancer patients ranges from NT$300,000 to over NT$1.3 million, a significant financial expenditure. The Breast Cancer Foundation cites research showing that many patients with early-stage breast cancer do not respond significantly to chemotherapy. On average, less than 2 out of 10 patients benefit from it.
Over-treatment may increase unnecessary burden on the body
Adherence to chemotherapy can lead to over-treatment, placing a greater burden on the body and increasing treatment costs. Dr. Choi Lai-yin, Honorary Medical Consultant and Surgeon of the Breast Health Center of the Hong Kong Breast Cancer Foundation, citing clinical research, points out that most early-stage breast cancer patients with positive hormone receptors do not gain additional therapeutic benefits from chemotherapy. Personalized treatment plans are developed based on individual circumstances to minimize side effects and impact on life.
She shared: “Doctors will predict the disease’s progression and decide on the next treatment plan based on tumor size, tumor grade, number of lymph nodes affected, hormone receptor response, tumor histology, and other factors. Additionally, they will evaluate treatment risks and methods based on the patient’s age, physical condition, wishes, long-term recovery, and other aspects.”
▲ Many patients are afraid of the side effects of chemotherapy, such as hair loss, vomiting, loss of appetite, etc. (iStock image)
Breast cancer tumor genetic testing is one of the methods. The results will reflect the recurrence index results, cancer recurrence risk, and chemotherapy benefit rate, helping to formulate treatment plans.
Genetic testing helps analyze chemotherapy effectiveness
Cai Lixian explained that the recurrence index results shown by breast cancer tumor gene testing range from 0 to 100. If the value is between 0 and 25, it means that receiving hormone therapy and adding chemotherapy simultaneously will have no benefit from chemotherapy, and the patient can avoid unnecessary chemotherapy. Conversely, if the value is between 26 and 100, it means that chemotherapy has a significant effect. Patients can use this data as a reference and discuss appropriate treatment options with their doctors.
“Previously, based on traditional clinical risk factor analysis, 73% of high-clinical-risk breast cancer patients had recurrence index results ranging from 0 to 25 (meaning no benefit from chemotherapy). Had “breast cancer tumor gene testing” not been done, these patients would have been over-treated.”
On the other hand, if a patient is assessed as low clinical risk and does not receive chemotherapy, but the genetic test result shows a score between 26 and 100, those patients may not receive adequate treatment.
New “Breast Cancer Genetic Testing Care Plan”
To help more breast cancer patients evaluate the effectiveness of chemotherapy and create appropriate treatment plans, the Hong Kong Breast Cancer Foundation launched the “Breast Cancer Genetic Testing Care Plan” to provide asset-test-free support to Hong Kong residents receiving treatment in public hospitals.
After patients pay for the test, if the results show that the recurrence index is between 26 and 100 points, they can apply for a full refund to reduce their financial burden of chemotherapy. Patients with the following three types of breast cancer can apply:
． Hormone receptor positive (HR+)
． Human epidermal growth factor receptor 2 negative (HER2-)
． Lymph node negative or lymph node positive (no more than 3 lymph nodes)
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Breast Cancer Treatment in Hong Kong: Understanding Chemotherapy Effectiveness with Genetic Testing
Breast cancer is a leading cause of cancer-related deaths among women in Hong Kong. While chemotherapy is often associated with cancer treatment, its effectiveness varies significantly among patients. Recent studies reveal that only a small percentage of early-stage breast cancer patients benefit from chemotherapy. This raises concerns about over-treatment, its associated side effects, and the substantial financial burden it places on patients.
The Reality of Chemotherapy Effectiveness
A “Breast Cancer Awareness and Treatment Opinion Survey” conducted by the Hong Kong Breast Cancer Foundation in June 2023 highlighted a widespread misconception about chemotherapy. Over 70% of respondents believed that chemotherapy and radiotherapy were essential for all breast cancer patients. However, the survey also revealed significant anxiety about the potential side effects of treatment. Notably, over 60% expressed a preference for alternative treatment options if available.
Data from the Hong Kong Breast Cancer Database indicates that the total cost of treatment for breast cancer patients can range from HK$300,000 to over HK$1.3 million. This substantial financial burden underscores the importance of understanding the effectiveness of chemotherapy before embarking on treatment. Research cited by the Breast Cancer Foundation suggests that, on average, less than 2 out of every 10 patients with early-stage breast cancer experience significant benefits from chemotherapy.
Over-treatment: A Major Concern
The potential for over-treatment, with its associated costs and side effects, is a serious concern. Dr. Choi Lai-yin, Honorary Medical Consultant and Surgeon of the Breast Health Center at the Hong Kong Breast Cancer Foundation, emphasizes the importance of personalized treatment plans tailored to individual patient circumstances. She highlights that many patients with early-stage breast cancer exhibiting positive hormone receptors may not derive additional benefits from chemotherapy.
Dr. Choi elaborates on the factors considered in formulating personalized treatment plans: “Doctors assess the progression of the disease, taking into account tumor size, grade, number of lymph nodes affected, hormone receptor response, tumor histology, and other factors. Alongside these factors, they also evaluate treatment risks and methods based on the patient’s age, physical condition, wishes, long-term recovery, and other individual aspects.”
▲ Many patients are afraid of the side effects of chemotherapy, such as hair loss, vomiting, loss of appetite, etc. (iStock image)
Genetic Testing: A Powerful Tool for Personalized Treatment
Breast cancer tumor genetic testing offers a valuable tool for personalized treatment planning. By analyzing the genetic makeup of the tumor, this test helps provide valuable insights into the likelihood of recurrence, the risk of cancer recurrence, and the potential benefits of chemotherapy.
According to Dr. Cai Lixian, the recurrence index results obtained through this testing range from 0 to 100. Scores between 0 and 25 indicate that combining hormone therapy with chemotherapy offers no additional benefit from chemotherapy. In such cases, patients can avoid the unnecessary burden and side effects of chemotherapy. Conversely, scores between 26 and 100 suggest significant benefits from chemotherapy. This data empowers patients to make informed decisions alongside their doctors.
“Traditionally, based on clinical risk factor analysis, 73% of high-clinical-risk breast cancer patients had recurrence index results ranging from 0 to 25 (meaning no benefit from chemotherapy). Without breast cancer tumor gene testing, these patients might have been over-treated,” highlights Dr. Cai Lixian.
On the other hand, patients assessed as low clinical risk who opted against receiving chemotherapy might benefit from the testing if their genetic results indicate a score between 26 and 100. This information helps to ensure that no potential benefits are missed.
The “Breast Cancer Genetic Testing Care Plan”
The Hong Kong Breast Cancer Foundation launched the “Breast Cancer Genetic Testing Care Plan” to provide financial support for Hong Kong residents receiving treatment in public hospitals. This initiative aims to empower more patients to evaluate the effectiveness of chemotherapy and make informed treatment decisions.
After completing the test, patients whose results indicate a recurrence index between 26 and 100 points can apply for a full refund, significantly reducing the financial burden associated with chemotherapy. The following breast cancer types are eligible for this program:
- Hormone receptor positive (HR+)
- Human epidermal growth factor receptor 2 negative (HER2-)
- Lymph node negative or lymph node positive (no more than 3 lymph nodes)
In conclusion, understanding the effectiveness of chemotherapy in breast cancer treatment is crucial for optimizing patient care. The “Breast Cancer Genetic Testing Care Plan” provides a valuable resource for Hong Kong residents, enabling informed decision-making and personalized treatment plans. By leveraging genetic testing, patients can gain insights into their individual chemotherapy response, potentially avoiding unnecessary treatment while maximizing their chances of successful recovery.
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