Chemotherapy is systemic drug therapy given either in pills or intravenously. By interfering with the ability of cancer cells to split and grow in the body, chemotherapy can help to shrink the size of existing tumors and can help prevent recurrences in patients who have had cancer.

Professional guidelines dating back to the early 1990's recommend that chemotherapy be considered for all women with invasive breast cancer, especially those with positive lymph nodes or estrogen receptor (ER) negative tumors. Despite its ability to help prevent recurrences among women with early stage breast cancer, it is not appropriate for every patient. Determining who should receive chemotherapy is a complex question that involves many factors.

The Comprehensive Breast Cancer currently uses many tools to guide such treatment decisions. A series of tests helps to gauge each patient's risk based on the size of her tumor, its grade (how aggressive it is), whether or not it has spread to lymph nodes, and whether the tumor is hormone-receptor positive or not.

Among the more recent tools available is a test to assess tumors for the expression of genes that are associated with risk of developing breast cancer recurrence in women who have traditionally been seen as low risk, particularly patients with hormone receptor positive, lymph node negative breast cancer. Studies have shown that based upon the expression patterns of these genes, some patients are more likely to experience breast cancer recurrences. Combined with evaluation of the other characteristics above, the profile of gene expression gives a more accurate assessment of a patient's risk of having recurrent cancer. Patients at Columbia are now being offered the opportunity to participate in national clinical trials to determine the efficacy of using risk profiles to predict benefits from chemotherapy in addition to hormonal therapy. Appropriate candidates may also participate in trials evaluating the newest chemotherapy treatments for early stage breast cancer. As an academic institution, Columbia University is committed to continually developing and improving treatments for breast cancer through research. The Clinical Breast Cancer Program is currently leading and participating in studies of many agents to treat different stages of breast cancer.

Columbia's efforts to advance breast cancer treatment include testing novel therapeutic agents to target cancer cells. At this time, the Breast Program's research team is studying chemotherapy in combination with drugs such as vorinostat, Avastin, Herceptin, Zarnestra, and others. In addition, we are studying many drugs in early stages of development to evaluate their potential for the treatment of breast cancer.

Although estrogen- and progesterone-receptor-positive disease can be controlled with hormones for months to a few years, receptor-negative tumors are treated with chemotherapy with a median duration of response of about a year and a median survival of 2 years. Patients should consider participation in a clinical trial if breast cancer recurs particularly when the disease spreads to other organs. However, patients whose tumors have not shrunk when treated with conventional therapy are seldom good candidates for new therapies. A history of breast cancer is often considered a contraindication for the use of oral contraceptives or estrogen replacement therapy, although these issues have never been rigorously tested.