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New study up-ends current surgical standards for breast cancer treatment: extensive node surgery frequently of no value

The Journal of the American Medical Association today published an article describing a breast cancer study funded by the National Cancer Institute.  The study involved more than 100 breast cancer treatment facilities and reviewed the records of almost  900 patients.  It followed the patients for a median time period of 6.3 years in an effort to assess whether they benefitted from extensive lymph node surgery.  The report concluded that for twenty percent of breast  cancer patients, that is about 40,000 women in the U.S. each year, taking out cancerous lymph nodes  does not change the treatment plan, does not improve survival and does not improve the odds of recurrence. 

Removing nodes for these women increases complications without any countervailing advantage.  The particular women involved are women with early, clinical stage T1 or T2 cancer, meaning a primary tumor less than two inches in diameter, with one or two armpit nodes that are cancerous but not sufficiently enlarged to be palpable, and no evidence of further metastasis. 

Treatment standards had been based on the assumption that even microscopic cancer in affected nodes should result in removal of the nodes in an effort to "get it all" surgically.  Investigators found, however, that patients meeting the above criteria should be treated with chemotherapy and radiation in any event, and that these modes of treatment result in the same outcomes for patients, regardless of surgical node removal of microscopic tumors. 

After the initial node biopsy, patients in the study were randomly assigned to one of two  treatment modalities.  One group experienced no further surgery, while 10 additional nodes were surgically removed in the other group.  Cancer was found in the removed nodes of 27 percent of women who experienced removal of  the  additonal nodes.  Nevertheless, after five years, 90 percent of the women in both groups survived, and recurrence rates in the armpit (which apparently occurs within five years, typically) were the same for both groups:  approximately one percent. 

With outcomes statistically identical, the authors recommend against the additional node removal since it increases the likelihood of complications from 25 percent to 70 percent. Complications can be very serious and include infections, sensory and motor nerve and muscle difficulties, and  particularly lymphedema.  Lymphedema affects almost one-third of patients who have armpit surgery and nearly half of patients who endure both surgery and radiation therapy.


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