PEMD-89-9: Published: Feb 28, 1989. Publicly Released: Apr 3, 1989.
- Full Report:
Pursuant to a congressional request, GAO assessed the extent to which the use of adjuvant chemotherapy changed the survival rates of premenopausal women with breast cancer which had spread to the lymph nodes.
GAO found that: (1) in 1975, two studies concluded that adjuvant chemotherapy showed promise as an effective cancer treatment; (2) in 1985, medical experts reached a consensus that adjuvant chemotherapy had demonstrated a significant increase in disease-free survival and a significant reduction in mortality in premenopausal women with breast cancer which had spread to the lymph nodes; (3) data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program indicated that there was no statistically significant increase in the 1975 through 1985 survival rates of patients identified as most likely to benefit from adjuvant chemotherapy; and (4) lack of treatment, inadequate control conditions, difficulty in detecting therapy benefits, and inadequate or inappropriate treatment could account for the lack of detectable improvement in survival rates.
Recommendation for Executive Action
Status: Closed - Implemented
Comments: The Department of Health and Human Services has completed the study in line with this recommendation. See Breslow, Lester. "Special Report: Measurement of Progress Against Cancer", Journal of the National Cancer Institute, 82, 1990.
Recommendation: The Secretary of Health and Human Services should initiate a study to determine why there has been no detectable improvement in the survival of premenopausal, node-positive breast cancer patients since the advent of chemotherapy in 1975. In light of the potential methodological obstacles that such a study faces, the Secretary should seek expert advice on the feasibility of conducting the recommended research and the study design most likely to provide valid conclusions.
Agency Affected: Department of Health and Human Services