Study: Lymph node removal not always needed for breast cancer patients
Study: Lymph node removal not always needed for breast cancer patients
The news is "very exciting," says Dr. Mehra Golshan, director of breast surgery at the Dana-Farber Cancer Institute in Boston. "It is practice-changing in many respects."
Until just a few decades ago, a breast cancer patient's primary option was a radical mastectomy, the removal of the entire breast and surrounding tissue, including the lymph nodes in the armpit. In the 1980s, studies showed that lumpectomies, which targeted just the tumors and spared much of the breast, worked well for many patients when coupled with radiation therapy.
Being able to retain the lymph nodes "is really a move toward less radical surgery" for breast cancer patients, study author Dr. Armando Giuliano, cancer surgery chief at the John Wayne Cancer Institute in Santa Monica, California, told the Associated Press.
During a lumpectomy, a few of the guardian or sentinel lymph nodes are removed and tested for cancer, explained Dr. Golshan, who was not a part of the study. Until now, if cancer was detected in even a single sentinel node, all of the axillary lymph nodes (the ones inside the arm pit) were removed. The idea was to stop the spread or recurrence of cancer, but the procedure often caused long-term complications, including numbness, loss of mobility, infection, and lymphedema—a chronic, incurable swelling of the arm.
The JAMA study involved about 900 women and found that, a little more than six years after treatment, overall survival rates were virtually identical for women who had retained their axillary lymph nodes (92.5 percent) and those who had theirs removed (91.8 percent). The disease-free survival rate was 83.9 percent for those who did not have their lymph nodes removed, and 82.2 percent for those who did. So, for breast cancer patients who meet the same criteria as those in the study, removing all of the axillary lymph nodes is not necessary—and keeping them could make for a better quality of life.
Women who undergo lumpectomies are normally also treated with chemotherapy or hormone-blocking drugs and radiation that targets the whole breast and part of the armpit. The study shows that this additional treatment may be enough to destroy cancer cells in any remaining lymph nodes. The study did not consider outcomes for women who do not have radiation or chemo, or for those who only have radiation applied to part of their breast; it is also not known whether the findings would be the same with other types of cancer. The median age of patients in the study was the mid-50s.
If you've recently been diagnosed with breast cancer, you and your medical team may be wondering how the JAMA study affects you. We turned to Dr. Golshan of Dana-Farber Cancer Institute for answers to some of the big questions:
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