Date of release: 14 December, 2009
Doctor, am I cured?
Introduction
Comment
Invasive cardiologists and cardiac surgeons often tell their patients after a coronary procedure that they now have a normal heart. This is, of course, false since a bypass or a stent may improve coronary blood supply, but cannot change the existence and potential development of atherosclerosis. What is the situation with cancer? Can we talk about cure from cancer? Results differ with various types of malignancies and level of medical care. A recent multinational European survey demonstrated various survival rates, starting with 4–13% for lung cancer, whereas breast cancer achieved the highest rates, in the order of 55–73% [2]. But a more important question is whether we can declare a real ‘cure’ when a certain uneventful period has elapsed since diagnosis and treatment? For example, in patients with colon cancer, a clear plateau in the relative survival curve is reached within 10 years of diagnosis, which indicates that cure may be achieved [3]. The current study uses elaborate statistical models for prediction of cure from breast cancer. As a matter of fact, the authors admit that this may well be the weakness of their results, since their methodology may not reflect the actual disease outcome. It is noteworthy that other groups have published studies that used different cure models. My personal knowledge does not allow me to get into the epidemiological arguments involved in such models, but still two basic facts remain: first, that prognosis vary with type and histology of breast cancer [4]; and, second, the longer the disease-free interval, the better chance for cure, although a definite cure cannot be claimed even after so many years of follow-up. A major relevant problem is that a substantial proportion of women have disseminated micro-metastatic disease at diagnosis, despite a primary tumor which is apparently localized [5]. The question whether a better breast cancer screening program and early detection of a tumor, combined with a more effective therapy, would lead to a higher percentage of cured patients still remains to be answered.
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