The NY Times reports today about a landmark breast cancer study that turned the accepted standard of breast
cancer treatment upside down. The new results apply to women whose disease and treatment meet the criteria in the study, and may not need the painful procedure that has long been routine: removal of cancerous lymph nodes from the armpit. There are approximately 40,000 women who meet the following criteria:
The tumors were early, at clinical stage T1 or T2, meaning less than two inches across. Biopsies of one or two armpit nodes had found cancer, but the nodes were not enlarged enough to be felt during an exam, and the cancer had not spread anywhere else. The women had lumpectomies, and most also had radiation to the entire breast, and chemotherapy or hormone-blocking drugs, or both.
After the initial node biopsy, the women were assigned at random to have 10 or more additional nodes removed, or to leave the nodes alone. 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. If breast cancer is going to recur under the arm, it tends to do so early, so the follow-up period was long enough, the researchers said.
The research for this study grew out of the desire to find alternatives to radical treatment for cancer, such radical dissection; which is the surgical excision of lymph nodes under a woman’s armpit. Radical dissection often led to complications such as lymphedema, infections, and fluid collection.
Reaction from the medical community
Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said: “It’s a big deal in the world of breast cancer. It’s definitely practice-changing.”
Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said surgeons had long been awaiting the results.
“In the past, surgeons thought our role was to get out all the cancer,” Dr. Estabrook said. “Now he’s saying we don’t really have to do that.”
Despite the findings of this study, there are still doctors, who are entrenched in their belief that lymph node surgery is still the standard of care for breast cancer. Change is difficult for all of us, so why not doctors? However, there is such a high percentage of women who experience severe complications from lymph node surgery, it is life-changing event to have a viable alternative to radical lymph node surgery.
If you are a woman who meets the criteria for this study, would you decline lymph node surgery?
Is it a violation of the standard of care not to inform a patient who meets the study’s criteria that lymph node surgery may not be unnecessary?
Please comment and share your experiences.