Thursday, January 5, 2017

Quest for the Cure Breast Cancer Treatment - Case Study Beatta

Second-Guessing the System


breast cancer
In December 1999, Beatta Campos, a 37-year-old mother with three daughters, noted a mass in her right breast and consulted her physician. He reassured her that the mass was benign. However, the following May, the mass began to burn and she then sought the advice of Dr. Sanchez Basurto, a respected surgical oncologist in Mexico City. He advised her to have an immediate biopsy.

The needle biopsy showed a carcinoma. So on May 27, 2000, she had a modified right radical mastectomy. The breast contained a 4 cm33 cm32.5 cm, moderately well-differentiated infiltrating lobular carcinoma. Unfortunately, lymphatic permeation was present and 4 of 26 nodes from the right axilla contained tumor. The cancer was ER1, PR1, and HER22. At this point, Dr. Basurto referred her to Blumenschein.

Beatta seemed to present a straightforward situation. Blumenschein proposed CAT 36 induction adjuvant therapy, followed by irradiation and long-term tamoxifen. He reassured her that she should have a 90% chance of surviving at least 10 years with this program. He explained the need for an indwelling central venous catheter to be inserted during the CAT portion of her treatment so that she could be given Adriamycin by continuous infusion. He also mentioned that, at age 37, most women
given these drugs have a high probability of entering menopause. If this did not occur spontaneously, it would be well to consider an oophorectomy soon after beginning tamoxifen.

Beatta had a great deal of concern about entering menopause because she had seen her grandmother suffer from severe depression when she entered menopause. In an effort to get her started on adjuvant chemotherapy, while keeping options open on ovarian function, Blumenschein added 7.5 mg of Lupron to the program with each course of CAT. She did well on this regimen. Although menstrual cycles ceased when she was given Lupron during her CAT program, they resumed when CAT was completed and Lupron could be discontinued. Her periods were regular and it was decided to follow her with more frequent observation. For some reasons, tamoxifen was never started.

Subsequently, Beatta remained under the care of a very competent medical oncologist, Dr. Raquel Gerson in Mexico and Blumenschein saw her infrequently. Almost 10 years to the date of her cancer diagnosis, he realized that she had never stopped her menstrual cycles and had not taken tamoxifen. The absence of recurrence after 10 years in a patient whose breast cancer was ER1, PR1 strongly suggests the CAT adjuvant therapy had successfully eliminated any residual tumor burden soon after
it was started.

Beatta appears to have second-guessed the system and won. It was quite possibly time for Blumenschein to rethink his 10-year rule for designating complete remissions as cures.

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