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Cutting Back on Chemotherapy

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Doctors treat most breast cancers pretty much alike, regularly administering chemotherapy to prevent metastasis although many patients would do as well with surgery alone. Ruth Heimann, an oncologist at the University of Chicago Medical Center, is working to develop a more individualized approach. "I call it giving the patient the Ôboutique treatment,' " she says.

She has zeroed in on E-cadherin, a protein molecule that zips together the outer membranes of cells. By examining breast tumors stored at the University of Chicago since 1927, Heimann learned that women whose tumors had the highest levels of E-cadherin were the least likely to develop metastatic breast cancer. She also noted two other useful markers--few blood vessels feeding the tumor, and a high concentration of a second cellular protein. Ninety percent of the women in the historical sample carrying all three markers were alive 14 years after mastectomy. Only 44 percent of those lacking the markers survived.

Heimann hopes an E-cadherin test will minimize the suffering of women with breast cancer. "The optimum would be to give chemotherapy only to those patients whom we are very sure will develop metastatic disease," she says.

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