Good news for some breast cancer patients
March 8, 2011
Removal of cancerous lymph nodes from the armpit may not be necessary in all breast cancer patients, according to a new study paid for by the National Cancer Institute. That's good news, especially since many patients develop complications after the lymph node removal, including infections and lymphedema, a potentially crippling, painful arm swelling.
For years, surgeons have been removing under arm lymph nodes, believing it prolongs lives by retarding the spread of cancer. The New York Times, February 8, 2011, reports that “Now, researchers report that for women who meet certain criteria – about 20 percent of patients, or 40,000 women a year in the United States ? taking out cancerous nodes has no advantage.” In these women, lymph node removal is unnecessary because chemotherapy and radiation wiped out disease.
“This is such a radical change in thought that it’s been hard for many people to get their heads around it,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study. Doctors and patients alike can accept more cancer treatment, but may feel afraid to do less.
Note that these study results will not apply to all women, but only to women who meet criteria used for the study: tumors were early, less than two inches across; biopsies of one or two armpit nodes found cancer, but the nodes were not large enough to be felt and the cancer had not spread anywhere else. Study subjects had lumpectomies; most had radiation to the entire breast and chemotherapy or hormone-blocking drugs, or both.
The study included 891 patients, median age mid-50s, who were followed for abut 6.3 years. After an initial node biopsy, the women were randomly assigned to have 10 or more additional nodes removed or to leave the nodes surgically untreated. In 27 percent of the women who had additional nodes removed, those nodes were cancerous. But over time, the two groups had no difference in survival: more than 90 percent survived at least five years. Recurrence rates in the armpit were also similar, less than 1 percent. Going forward, women, such as those in the study, will have one lymph node removed and then make a decision about more treatment.
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