Q: Do all breast cancer patients have to have chemotherapy?
A: No, chemo is used less and less. Five years ago, we considered chemo for most breast cancer patients; now it's only about 20%. There are tests to help decide if someone needs chemo or not. But we also look at a tumor's grade and whether the cancer is estrogen-receptor negativein which case, it won't respond to hormone therapy, but it may respond to chemo.
Q: What does chemotherapy do?
A: Chemotherapy disrupts the ability of cells to survive and grow by interfering with DNA. Cancer cells are more sensitive to chemo since they are usually the most active cells in the body, but normal cells are disrupted toothat's what causes you to experience side effects. Side effects can include hair loss, nausea, irritation of the gut, or a decrease in blood cell counts that can lead to infection, anemia, fatigue, or bleeding.
Q: I've heard chemo isn't as toxic as it used to be. Is that true?
A: Yes, chemo is generally a lot easier to tolerate now than it was 20 years ago, because with lower doses and less toxic combinations, there are fewer and less difficult side effects. There are also lots of drugs you can take now to fight the nausea, vomiting, and low-white-blood-cell counts. And on some of the newer chemo meds, especially those used to treat relapsed, metastatic breast cancer, you may even keep your hair.