Removing only one to three key lymph nodes instead of the usual dozen or more can spare women lifelong arm problems and reliably indicate whether breast cancer has spread and needs...
SAN ANTONIO Removing only one to three key lymph nodes instead of the usual dozen or more can spare women lifelong arm problems and reliably indicate whether breast cancer has spread and needs aggressive treatment, the first big study to test this approach has found.
Many doctors have been doing this without proof that it is as good as the standard operation, and they still don’t know whether it will hurt women’s survival odds.
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But the large, federally funded study has answered at least the accuracy question, finding that the less-severe surgery is 97 percent accurate at revealing whether cancer has spread beyond the breast.
“There is a high degree of accuracy here,” said Dr. Thomas Julian, a breast-cancer surgeon at Drexel University College of Medicine and Allegheny General Hospital in Pittsburgh.
“This offers an option for the majority of women,” he said.
He presented the research yesterday at a breast-cancer conference in Texas.
Dr. Stephen Edge, a surgeon at Roswell Park Cancer Institute in Buffalo, N.Y., called it “a landmark study that many of us, including me, thought was undoable,” because so many women already demand the less-severe surgery.
Julian’s study involved 5,260 women in one of the longest-running cancer studies in history, the National Surgical Adjuvant Breast and Bowel Project.
It is known for such watershed findings as proving that removing only a cancerous lump was as good as removing the entire breast for most women, and establishing benefits of chemotherapy and tamoxifen.
All women in the new study had an average of three sentinel nodes removed. Half then went on to have the usual 10 to 20 nodes removed. The others had more nodes removed only if the sentinel ones had cancer.
In 96 percent of cases, when the sentinel nodes did not contain cancer, no other nodes in the armpit did. The false negative rate when the sentinel nodes were believed to be cancer-free but the disease was present in other lymph nodes was nearly 10 percent.
That is higher than some smaller studies have found but comparable to that of the tissue-examination tests used now to declare cancer present or absent. And it is probably close to what women can expect in the real world, since this study involved more than 230 surgeons throughout North America, including many who do not specialize in breast cancer.
“It shows that a broad population of surgeons can carry this out,” Julian said.
Kissin presented a separate British study of more than 1,000 women that documented how devastating the standard lymph-node surgery can be: 37 percent of women had loss of arm sensation at six months, compared with 14 percent who had the sentinel-node approach. They also had higher rates of lymphedema.
“There shouldn’t really be a choice anymore. Sentinel node, for the patient, should be the standard of care,” he said.
Edge and others said such a recommendation should wait until after the trial can provide information on long-term survival.