When breast cancer has spread to a patient's lymph system, surgeons traditionally have operated to remove a large number of underarm lymph nodes, to eliminate any trace of the cancer. The procedure is effective, but it can cause permanent complications. Now, a new study shows there is no advantage to taking out so many lymph nodes, and the finding could mean major changes in breast cancer surgery.
When breast cancer spreads to nearby lymph nodes, doctors have two choices: they can remove the main tumor and the one or two lymph nodes closest to it. This is called sentinal node biopsy. Or, they can go with a more aggressive approach and take out a large number of lymph nodes.
The more aggressive approach can wipe out the cancer, but complications often include shoulder pain or permanent and painful swelling of the arm.
Dr. Armando Giuliano at the John Wayne Cancer Institute in the western state of California wanted to see if the cancer could be eliminated with less aggressive surgery. "Removing fewer lymph nodes results in less pain, less morbidity,” he said. “It's an outpatient procedure."
The more radical surgery requires a one- or two-day stay in a hospital, and results in greater post-operative pain.
Dr. Armando Giuliano
So Bobbie Saunders was relieved when her doctor offered to perform the less radical procedure when she was diagnosed with breast cancer eight years ago. "I had already experienced a lot of people that had been through the radical, so I was really excited that I was offered this," she stated.
Dr. Giuliano and researchers at several top cancer centers in the U.S. studied nearly 900 patients whose breast cancer had spread to just one or two lymph nodes. Half had the more radical procedure while the others had the simpler surgery. Both groups had radiation treatments and chemotherapy.
"The five-year survival [rate] was about 92 percent, regardless of which operation [they had]. And wonderfully, women who had the sentinal node biopsy alone did just as well as the women who had the more radical operation," Dr. Giuliano explains.
Researchers say combining chemotherapy and radiation with the simpler surgery accounts for the high success rate of the less radical procedure.
Some experts say the study is likely to change the way surgeons treat early-stage breast cancers that have spread to the lymph nodes. But other cancer specialists -- and their patients -- say they want more proof before changing the standard practice. The study was published in the Journal of the American Medical Association.