The February 9, 2011 issue of the Journal of the American Medical Association published the final results of an important trial about how much surgery is needed for patients with early stage breast cancer to see if cancer has spread into their lymph nodes. This study questioned the need to have a large number of lymph nodes removed if one of the nodes is found to have cancer in it at the time of breast surgery. The answer from this study is no.
Patients who have an early stage breast cancer have a choice as to what type of surgery they want for their breast – a lumpectomy, which removes only the tumor, or a mastectomy to remove the entire breast. However, modern guidelines were needed about how much surgery is needed in the axilla, or underarm, to determine if the cancer has spread into the lymph nodes.
Traditionally during breast surgery, a small number of lymph nodes are first checked to see if cancer has spread into them. This process is known as a “sentinel node biopsy.” If any of the nodes was found to have cancerous cells in it, then the surgeon would do a second procedure to count the total number of lymph nodes into which the cancer had spread. This process is called an “axillary nodal dissection.”
While an axillary nodal dissection is helpful to know the total number of nodes into which cancer has spread, it comes at a cost. Patients who undergo this procedure are more likely to develop shoulder pain, shoulder weakness, and chronic swelling of their arm. All of these can dramatically impact a patient’s ability to use their arm on a daily basis, which can truly alter their quality of life.
So the purpose of the study was to see if patients who were found to have cancer during the first procedure, the sentinel node biopsy, need to have the second procedure, the axillary nodal dissection. The results of the trial found no difference in the survival of women who had just the first procedure compared to the women who had both the first and second. In addition, there was no difference in how likely it was for the cancer to recur in both groups either.
Why is this the case? Modern improvements in chemotherapy, radiation therapy, and radiology have had a substantial impact in the lives of patients with breast cancer over the last 20 years. Improvements in radiology with mammography and breast magnetic resonance imaging (MRI) have made it easier to detect cancer in a patient’s breast and axilla. New chemotherapy drugs have made large gains in saving patient’s lives and radiation therapy is being delivered more precisely and effectively.
It is nice to see that all of the research and improvements in treating patients with breast cancer are paying off. Based on this study, those with an early stage breast cancer may now be able to have a less aggressive surgery and look forward to living with a better quality of life.
Dr. Cynthia Anderson is Radiation Oncologist with Memorial Hospital’s Southside Cancer Center.