From Mark Levine, the Doc with Pink Tights
The History of the Breast Cancer Team: Part II
By Dr. Mark Levine

Read part 1
This is a continuation from where I left off in the November eNewsletter, with the results of the trial comparing 36 weeks with 12 weeks of chemotherapy after breast cancer surgery. The results of this trial were important as they suggested that 12 weeks of chemotherapy with CMF-type chemotherapy was not enough; it was too short a duration.

(CMF chemotherapy uses three anti-cancer agents: cyclophosphamide, methotrexate, and 5-fluorouracil (5-FU).)

In 1990, the results were published in a leading oncology journal. While we were conducting the trial, we also carried out studies that had a global impact. We developed one of the first quality-of-life questionnaires tailored specifically for women with breast cancer receiving chemotherapy. In addition, we were one of the first groups to recognize that chemotherapy causes thrombosis (blood clots). This was very exciting for all of us, as the results were published in the New England Journal of Medicine, the #1 medical journal in the world.

In the early 1990s, Dr. Tim Whelan, a radiation oncologist, arrived from the Maritimes. He wished to pursue research training at McMaster University and the Hamilton Regional Cancer Centre (HRCC). After completing a two-year fellowship under my supervision, he joined the medical staff of the HRCC.

Dr. Whelan had a passion for research and his area of interest was breast radiation after surgery. He was instrumental in putting Hamilton on the map in terms of leading breast cancer radiation research. There are many examples of his work.

If I am telling the story in chronological order, the first radiation trial we were involved with was the Ontario Clinical Oncology Group (OCOG) Stage I trial. (I will talk more about OCOG in a separate article). In the 1980s, lumpectomy was emerging as a surgical treatment of breast cancer. What was unclear was whether radiotherapy to the breast after the lumpectomy reduced local (in-breast) recurrence of the cancer. If the cancer came back in the breast, then a mastectomy was done.

We designed a trial in which more than 800 Ontario women with Stage I breast cancer were randomly allocated to radiation or not. Dr. Roy Clark from the Princess Margaret Hospital, Dr. Peter McCulloch from the HRCC, and I led the trial. Dr. Whelan worked on the trial during his research training.

The results of the trial showed that radiation reduced recurrence from about 25% to about 5%; thereby avoiding a mastectomy. Our Ontario trial was one of three in the world that resulted in a change in practice, with radiation therapy becoming standard after lumpectomy.

To be continued……