Study casts doubt on effectiveness of routine lymph node removal in some women with early breast cancer

Many women with early breast cancer do not need to have their armpit lymph nodes removed, according to a new study. Currently, this painful procedure has long been routine, as physicians believed it would prolong women’s lives by keeping the cancer from spreading or coming back. However, the study shows that removing the cancerous lymph nodes is unnecessary when women receive chemotherapy and radiation, which wipes out most of the disease in the nodes.

The study indicates that for about 20% of women (40,000 women a year in the U.S.), the removal of the cancerous lymph nodes doesn’t (a) alter the treatment plan for the patient; (b) improve survival rates; or (c) make the cancer less likely to recur. And it has a downside, since it can cause complications like infection and lymphedema, a chronic swelling in the arm.

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. However, they warn that change may come slowly because the notion that the nodes must be removed is very deeply ingrained.

The current approach to surgical treatment of breast cancer is to cut out obvious tumors – because lumps big enough to detect may be too dense for drugs and radiation to destroy – and to use radiation and chemotherapy to wipe out microscopic disease in other places. Until now, physicians believed that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival.

The new results do not apply to all patients, only to women whose disease and treatment meet the criteria in the study, which were:

Early tumors at clinical stage T1 or T2 (i.e. less than two inches across).

Biopsies of one or two armpit nodes 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.

The study included 891 patients with their median age in the mid-50s. After an initial “sentinel” 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.

Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, who authored an editorial that accompanied the study, said that by routinely taking out many nodes, “I have a feeling we’ve been doing a lot of harm.”

Source: The New York Times

You can read an abstract of the study here.

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