SUPREMO comes from some of the letters in the full title of the trial: ‘selective use of postoperative radiotherapy after mastectomy’.
The first line of treatment for breast cancer is usually an operation to remove the growth. Most women nowadays will have ‘conservative’ surgery, where only the part of the breast containing the cancer is removed. This is usually followed by radiotherapy to the remainder of the breast. However, a considerable number of women still prefer to have a mastectomy, where the whole of the breast is removed.
The need for radiotherapy after a mastectomy is less certain than following the more conservative surgery. The aim of the radiation is to prevent tumour coming back (a local recurrence) in the scar, or the surrounding skin on the chest (and also, possibly, to increase the chances of a long-term cure).
If a woman has a large breast cancer, or if the operation shows that the growth has spread to more than three lymph glands under the arm, next to the breast, then her chances of getting a local recurrence are quite high, and radiotherapy is usually given.
But for women with smaller tumours, and fewer, or no, lymph nodes involved, the risks are much lower, and the need for radiotherapy less certain.
Because of this uncertainty doctors in Britain have set up the SUPREMO trial. In the trial, women who have had a mastectomy for a breast cancer and come into this uncertain risk group, will either be given no radiotherapy, or a routine course of radiation to their chest. Women who agree to take part in the study won't actually be able to choose whether or not they have the radiotherapy – the selection will be done by a computer, to ensure that choices by either patients or their doctors can't influence the results.
Going into the trial does not affect any other treatments that you might need, like chemotherapy or hormone therapy, these will still be given routinely, as necessary.
As with all clinical trials the choice as to whether or not you take part is entirely your own, and your doctors will completely understand if you decide you are not keen, and will still ensure you get the best possible care. But if you do take part then you will be helping to answer an important question about the treatment of breast cancer following a mastectomy.