Some With Breast Cancer May Be Able to Skip Full Lymph Node Removal
Article date: February 9, 2011
By Eleni Berger
Removing all of a woman’s underarm lymph nodes may be unnecessary for some breast cancer patients, according to a new study. It found that survival rates did not differ much when women had only the sentinel lymph node removed, a simpler procedure that could spare them unpleasant side effects.
The findings could change the standard of care for some women with breast cancer, the authors say. Right now, doctors typically check for breast cancer spread by removing and testing the sentinel lymph node – the lymph node (in the underarm) where the cancer is likely to spread first. If cancer is present in that node, doctors typically remove all the woman’s underarm lymph nodes to help keep the cancer from coming back or spreading further. This surgery is called axillary lymph node dissection.
Though effective, full lymph node removal can cause lymphedema – a painful swelling of the arm – as well as weakness, shoulder pain, and prickling or tingling sensations in the arm and shoulder. Sparing women these side effects without lowering their chance of survival would be an important treatment advance.
Equally good survival, fewer side effects
That’s what happened in this study, which was conducted by the American College of Surgeons Oncology Group. It was published in Wednesday’s issue of the Journal of the American Medical Association.
The women who took part all had stage 1 or 2 breast cancer that had spread to the sentinel lymph node. They were randomly assigned to have full lymph node removal or only sentinel node removal, along with lumpectomy and whole-breast radiation.
After about 6 years of follow-up, survival rates were about the same in the two groups, about 92%. Rates of disease-free survival (how long the women lived without a recurrence of their breast cancer) and recurrence of the cancer in the underarm were also similar.
Side effects were not similar, though. About 75% of women who had all lymph nodes removed reported side effects like wound infections and tingling sensations, compared to just 25% of the women who had only sentinel node removal. Those who had only sentinel node removal also reported less lymphedema.
“This study and others like it may ultimately change the standard for breast surgery among women with breast cancer who have sentinel nodes that test positive for the disease. It may also lead to breast cancer treatments that cause less harm,” said Otis Brawley, MD, Chief Medical officer for the American Cancer Society. He was not involved in the study.
More study of other treatment scenarios needed
The authors say their results suggest removing all lymph nodes may not be necessary – for certain breast cancer patients.
The study did not include women who had mastectomies, those who had lumpectomy without radiation, those who had chemotherapy or hormone therapy before surgery, or those who got partial breast radiation or a different type of whole breast radiation. For these women, full lymph node removal is still the standard of care when the sentinel lymph node has cancer in it, the authors say. More studies will need to be done to determine whether only sentinel node removal is also an option for them.
For more information on breast cancer surgery, see the treatment section of our Breast Cancer Detailed Guide.
Reviewed by members of the ACS Medical Content Staff.
Citation: Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial. Published in the Feb. 9, 2011 issue of JAMA (Vol. 305, No. 6). First author: Armando Giuliano, MD, John Wayne Cancer Institute, Santa Monica California.
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