Breast Cancer Treatment (new study)

Sometimes less is more, and in the case of breast cancer surgery this seems to the case.  In a  just released study on women with breast cancer, it turns out that the removal of cancerous lymph nodes may not always be necessary.   The results of this study will facilitate major changes in the way breast cancer is treated, and could be hard for a lot of women to accept at first; since most of us are programmed to want all cancer removed.  But it turns out that about 20% of breast cancer patients who have cancer in their lymph nodes and who would normally have those nodes removed, will not need this aggressive surgery.

The new study concludes that the decision of whether or not to remove the lymph nodes should now be based on what stage the breast cancer is in, rather than the finding of cancer in the  nodes.

This is from the New York Times – Lymph Node Surgery for Breast Cancer Not Always Needed

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

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.

So why is this such an important discovery in the treatment of breast cancer?

It’s because in patients where the removal of these nodes do not change the outcome of survival or re-occurrence, the benefits of removal do not outweigh the risks.   Not only is the removal of these lymph nodes very painful to recover from, but the complications (such as infection and lymph edema) can be very serious, even disabling.  So if doctors can eliminate this complication for over 40,000 women a year, that is a very good thing.

Here is a video discussing this latest study…

From the Washington Post – Breast Cancer Study Questions Lymph Node Removal

The study, involving nearly 900 women who were treated at 115 sites across the country, found that those who did have their lymph nodes removed were no more likely to survive five years after the surgery than those who did not, the researchers reported in a paper published in the Journal of the American Medical Association.

Even though the cancerous lymph nodes will not be removed during surgery for patients meeting the new criteria, the cancer in those nodes is eradicated when the patient is given chemotherapy after surgery.

More from the New York Times article…

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in the nodes, the researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realization that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients.

What do you think about this new study and how it will affect the treatment of breast cancer?  Do you agree with the findings of the study?  What would you want to do if you fell into this new criteria, and the recommendation was to not remove the lymph nodes?  Please let us know your thoughts in comments.

(cross-posted to BlogHer)