Treatments for breast cancer have improved in the past few years, and many women are living longer than they would have previously. For women with breast cancer that has spread to their lymph nodes, surgery combined with high-dose chemotherapy has become the standard care, after several studies touted its superiority. However, the scientific evidence for high-dose chemo is not air tight, and some scientists from England decided to take another look to see if that method really is better than lower-dose, conventional chemotherapy.

What the scientists wanted to know: Does high-dose chemotherapy increase the survival rate more than conventional chemo in women whose breast cancer has spread to their lymph nodes?

What they did: Over a four-year period, the researchers enrolled 605 women who had breast cancer that had spread to four or more lymph nodes but not beyond that area. All of the patients who needed surgery had it. Then, the patients were separated into two groups: one group received a conventional regimen of chemotherapy doses and the other group received one conventional round of chemo followed by a high-dose cycle, in which the different combinations of drugs were given more frequently. Some patients in both groups took tamoxifen, a hormone known to help treat cancer in some women, after the completion of their chemotherapy. All of the women were followed for several years to see if they relapsed.

What they found: The survival rate among all the women in the survey was the same, regardless of whether they were in the high-dose or conventional chemotherapy group. After five years, 54 percent of the women in the conventional group had relapsed, and 57 percent of the women in the high-dose arm had relapsed. In the high-dose arm, there were five deaths that were attributed to the treatment; none of the women in the conventional-dose arm died because of treatment.

What it means to you: This study shows that higher-dose chemotherapy may not decrease relapse rate or improve a woman's chance of survival more than conventional chemo regimens. High-dose therapy also tends to make women sicker and has more risks than conventional chemo and now, it seems, may be no more effective.

Caveats: This study tested the specific regimen of a conventional round of chemo followed by a single round of high-dose chemotherapy. It may be that more than one cycle is needed to be effective or that these doctors didn't use the most effective combination of drugs. Other high-dose methods may work better than the regimen tested in this study.

Find out more: The National Cancer Institute has a user-friendly site explaining treatment options for breast cancer.

The Susan G. Komen Foundation, home of the famous pink ribbon, has a Web page where you can find out about treatment options sorted by type of breast cancer.

Read the article: Leonard, R.C.F. et al. "Conventional Adjuvant Chemotherapy Versus Single-Cycle, Autograft-Supported, High-Dose, Late-Intensification Chemotherapy in High-Risk Breast Cancer Patients: A Randomized Trial." Journal of the National Cancer Institute. July 21, 2004, Vol. 96, No. 14, pp. 1076–1083.

Abstract online: http://jncicancerspectrum.oupjournals.org