When it comes to modern medicine, there are few treatments as crude or as primitive as chemotherapy -- a poison that kills cancer cells and lots of healthy cells as well.
The treatment often causes fatigue, nausea and hair loss, and is used on more than half of the 200,000 Americans women diagnosed with breast cancer each year after surgery to prevent the cancer from spreading to other parts of the body.
But there is a growing debate among some doctors over whether all this chemo is needed.
"We are beginning to back off in selected patients on chemotherapy, and these are patients who several years ago might have received chemotherapy," said Dr. Eric Winer at the Dana Farber Cancer Institute.
"I am personally reluctant to withhold chemotherapy right now on the basis of evolving and incomplete data," said Dr. Clifford Hudis at the Memorial Sloan-Kettering Cancer Center
Winer and Hudis are two of the country's leading breast cancer specialists. They are also the best of friends and talk on the phone almost every day, but when it comes to prescribing chemotherapy they do not see eye to eye.
"The information that we have is evolving relatively rapidly and there are some doctors who are a little more willing to change their practice," Winer said.
Doctors now know that 70 percent of breast cancers are fueled by estrogen. And new, milder, nonchemotherapy medications can help prevent these cancers from returning.
In addition, doctors are using new genetic tests to help identify which specific breast cancers are more or less likely to respond to chemotherapy.
"We're learning that at least some of those women probably get a very, very small benefit from chemotherapy," Winer said.
But his friend and colleague warns that it's too soon to cut back on these treatments.
"Even with these new tests I don't know that I can pick out patients who should not get chemotherapy," Hudis said. "Having learned to give it in a safe fashion and seeing a falling death rate, I want to be convinced I can safely withhold it."
The debate about whether to use chemotherapy on different breast cancer patients is likely to grow more intense over the next decade. A national clinical trial that will help answer those questions is just now beginning.