Big Changes in Dealing with Breast Cancer

| by Toni Brayer MD

I always say that medicine is a dynamic changing field and today's JAMA study on the standard practice of removing lymph nodes in women with cancer is flipping medicine on it's head.  For over 100 years, the standard practice has been to remove cancerous lymph nodes in early stage breast cancer. 

It has been common practice to sample these nodes and remove them if there was any evidence of cancer, with the hopes of stopping further spread.  It made common sense and it was done by all surgeons.  Women who had their underarm lymph nodes removed often suffered complications and severe persistent lymphedema arm swelling and pain.  But it was considered the price to be paid to be cured of cancer.

The new study, which examined data from 900 women,  showed no difference in 5 year survival rates between women with lymph nodes removed and those who did not.  These results will change the way we practice medicine.

Cancer is found in lymph nodes in about 1/3 of the 200,000 women with breast cancer in the United States each year.  Even women who have lumpectomy rather than mastectomy, have undergone lymph node removal.   To spare women the complications, doctors sample one "sentinal" node and continue removing them if that shows cancer.  This study shows there is no advantage to removing additional nodes, even if cancer is found.

It should be noted that this study only applies to women with T1 or T2 tumors, meaning small and with no enlarged nodes that could be felt.  It also excluded women with other know metastasis.

But 60-70% of women with breast cancer found in lymph nodes may not need to have those nodes removed and they will be spared additional surgery and complications.

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