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WEDNESDAY, Oct. 3, 2018 (HealthDay News) – Many elderly women with breast cancer may be feared to be struck by a "chemo brain" after their treatments, but a new study suggests that only people carrier of a gene linked to the face of Alzheimer's this risk.
The researchers found that breast cancer survivors carrying the APOE4 gene who had received chemotherapy were more likely to experience long-term impairment of brain function.
But the study did not prove that the gene was at the origin of the cognitive problems known as chemo-brain. And the observed declines were low, added the study's authors.
"It was only a small group that had cognitive problems after chemotherapy treatment, and these women had a distinct gene from APOE4," said lead researcher, Dr. Jeanne Mandelblatt. . She is Professor of Oncology at the Lombardi Cancer Center in Georgetown, Washington, D.C.
These results are good news for the vast majority of breast cancer survivors. The results showed that most women who received chemotherapy or hormone therapy did not experience long-term thinking or memory decline related to their cancer or treatment.
"Our study suggests that for most elderly patients with breast cancer, chemotherapy and hormonal treatments do not have major adverse effects on cognitive function, at least such as measured by our current tests, "said Mandelblatt.
Experts have long feared that older people are more likely to have memory and thinking problems related to cancer treatment, said Mandelblatt.
Aging is already linked to dementia and Alzheimer's disease, she noted, and older people also face a number of other health issues that affect their thinking ability .
For the study, researchers recruited 344 breast cancer patients aged 60 to 98 years. These women were compared to 347 healthy women of similar age to determine whether breast cancer or its treatments were causing an intellectual decline.
Both groups of women received a battery of 13 cognitive tests early in the study, before cancer patients received no treatment. They were re-tested one and two years later.
The tests showed that women treated with hormone therapy had no long-term cognitive problems, whether or not they had the APOE4 gene.
But breast cancer patients with the APOE4 gene experienced a significant decline in thinking and memory if they received chemotherapy, the researchers reported.
"The APOE4 gene is a very strong genetic risk factor for Alzheimer's disease," Mandelblatt said. "There is probably some interaction between chemotherapy and something that this gene is controlling, but we are very cautious about saying that this discovery needs to be replicated, and we need to inform the lab to better understand the mechanisms and pathways that are involved. # 39; s access. "
Mandelblatt said that only 20% to 25% of people were HIV-positive for APOE4 and that less than 30% of older women with breast cancer were receiving chemotherapy.
And she pointed out that the observed mental declines were not important.
"The types of cognitive changes we observed even in this group that presented a genetic risk, these changes were relatively mild and did not represent the magnitude that you see in Alzheimer's disease," Mandelblatt said. . "We do not want women to worry about having serious memory problems – these were minor declines in their cognitive abilities."
So, it is too early to include the APOE4 gene in discussions on breast cancer treatment, Mandelblatt said.
"We need more research before we can make such a recommendation," concluded Mandelblatt. "The main consideration for women in choosing their treatment is to survive their cancer.If their cancer is more advanced, they will want to choose the most aggressive treatment to survive their disease."
A cancer expert accepted.
The current trend is to use chemotherapy less often to treat patients with breast cancer, given recent findings that this technique is often not necessary, said Dr. Len Lichtenfeld, Assistant Medical Director of the American Cancer Society.
"On the other side of the equation, women whose breast cancer has recurred may require chemotherapy, and it may not be possible to avoid it, even with the presence of breast cancer. this gene, "said Lichtenfeld.
More research and discussion is needed before the treatment guidelines are modified to address the APOE4 gene, said Lichtenfeld.
"It is very rare that we immediately change course on what we are doing," said Lichtenfeld. "We definitely need more research and discussions before we routinely test women for the presence of this gene."
The study was published on 4 October in the Journal of Clinical Oncology.
More information
The US National Institute on Aging has more about genetics and Alzheimer's disease.
SOURCES: Jeanne Mandelblatt, MD, MPH, Professor of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C .; Len Lichtenfeld, M.D., Assistant Medical Director, American Cancer Society; October 3, 2018, Journal of Clinical Oncology
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