Post menopausal women and patients with four to ten positive lymph nodes did not evidence a benefit from receiving the combination chemotherapy. Interestingly, of nine women who had more than ten positive nodes and received no combination chemotherapy, none were alive twenty years later compared to three of eighteen patients who had received CMF chemotherapy and were alive twenty years later. The authors attempted to explain why post menopausal women did not benefit from chemotherapy like pre-menopausal women. Some suggested that the only benefit of chemotherapy was to ablate the ovaries thereby eliminating this source of hormone production. Others proposed that older women received lower doses of chemotherapy, therefore, yielding a lesser benefit.
Some women fear that the diagnosis of cancer means death.
The potential advantage of receiving chemotherapy early on is to remain free of cancer. However, it should be noted that there was, as well, a group of women alive with cancer twenty years after the diagnosis was made. The report by Bonadonna and his colleagues demonstrates that the effects are lasting. Certainly, there have been many great strides taken since this study was commenced twenty-two years ago. They occurred on the shoulders of giants.