Treating early breast cancer has often meant surgery to remove the lymph nodes from deep inside the armpit, but in many cases that painful procedure may be completely unnecessary.
A new study suggests that for women meeting certain medical criteria–about 40,000 Americans per year, or 20 percent of breast cancer patients–there is no medical benefit to the lymph node surgery, a finding that promises to radically alter the way doctors approach the disease.
The study, which has been published in the Journal of the American Medical Association, tracked close to 900 women being treated at 115 sites around the U.S., roughly half of whom had been subjected to the lymph node surgery. Not only did the surgery fail to reduce the likelihood of recurrence of cancer or improve rates of survival, lymph node surgery also imposes the risk of infection or lymphedema, a disorder that causes chronic swelling of the arm.
According to The New York Times, researchers said that removing the cancerous lymph nodes proved unnecessary because the women in the study received chemotherapy and radiation, which probably wiped out any disease in the nodes.
“It’s a big deal in the world of breast cancer,” Dr. Elisa R. Port, chief of breast surgery at Mount Sinai Medical Center in New York and an expert who wasn’t involved in the study. “It’s definitely practice-changing.”
Some medical centers, familiar with the study’s findings before its publication, have already reduced the application of lymph-node surgery. But the study’s authors, who represent a variety of cancer centers from around the U.S., say that such hospitals are in the minority.
“It shouldn’t come as a big surprise, but it will,” said Dr. Armando E. Giuliano, lead author of the study and the chief of surgical oncology at the John Wayne Cancer Institute at St. John’s Health Center in Santa Monica, Calif. “It’s hard for us as surgeons and medical oncologists and radiation oncologists to accept that you don’t have to remove the nodes in the armpit.”
