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New breast cancer finding suggests limiting surgery

The New York Times yesterday published an article about a new study in the Journal of the American Medical Association. The study indicates that it may not be necessary to remove cancerous lymph nodes in the armpit of women with early-stage breast cancer. The finding is important because lymph node removal is associated with a number of serious complications including shoulder pain, numbness and lymphedema (a swelling of lymph passages in the arm that can be uncomfortable and even debilitating). The recent research indicates that, in select cases, radiation after lumpectomy can instead eradicate cancer in affected nodes. Times reporter Denise Grady writes:

After the initial 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. If breast cancer is going to recur under the arm, it tends to do so early, so the follow-up period was long enough, the researchers said.

Stanford's chief of breast surgery, Irene Wapnir, MD, had this to say about the study:

The findings are interesting, but it's important to remember that this study focused on a select group of women - those with tumors no more than five centimeters in diameter who had a lumpectomy followed by radiation therapy. As a result, the findings may not apply to women who have had a mastectomy or those treated by partial radiation therapy after lumpectomy. It's possible that the two groups in this study experienced similarly low rates of local recurrence because the radiation field used encompassed a significant portion of the armpit, which may not be the case for more highly targeted radiation therapy.

Wapnir, who chairs a multi-center national trial investigating the optimal systemic treatment for women who develop a local or regional recurrence of breast cancer after mastectomy or lumpectomy, concluded by saying that the ultimate decision about treatment options for breast cancer must be individualized:

We are not yet at a point where we can abandon axillary node dissections. Stanford is currently participating in an ongoing national clinical trial designed to assess local recurrence rates after lumpectomy and partial radiation involving patients with up to three positive sentinel lymph nodes. If this study reaches similar conclusions, physicians and patients may begin to feel more comfortable when choosing a less-aggressive form of treatment.

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