Early breast cancer cases may not need extensive lymph node examination. (National Cancer Institute )
Some women with early-stage breast cancer may be cured without the need to remove multiple lymph nodes, which has been the standard practice, researchers reported Tuesday.
Breast cancer surgery traditionally includes removal of lymph nodes near the tumor so that doctors can check for evidence that the cancer has spread. However, a new study found that people with early-stage breast cancer that has spread to a nearby lymph node fared just as well after treatment without the removal of additional lymph nodes in the armpit area.
Taking out those extra nodes, called axillary nodes, has a distinct downside because it can leave some women with swelling and stiffness in the arm.
The study, published in the Journal of the American Medical Assn., examined 891 patients who had an early-stage tumor. All of the patients had their tumors removed via lumpectomy — meaning just part of the breast is removed, not the entire breast — and then had radiation therapy. Most of the women also had chemotherapy.
All the women in the study had evidence of cancer in the one or two nodes closest to the tumor, known as the sentinel lymph nodes. In about half of the women, however, doctors also removed at least 10 axillary lymph nodes. The average number of axillary nodes removed was 17.
Cancer was found in the axillary lymph nodes in 27% of the women in the study. Nevertheless, after an average of about six years, the study showed little difference in cancer recurrence or survival between the women who had many nodes removed and those who had only the sentinel nodes removed.
The five-year survival rate was 91.8% in the women with axillary-node removal, compared with 92.5% with sentinel-node-only removal. This difference was not statistically significant.
As expected, the patients who had axillary nodes removed had more complications from surgery, including infections and swelling. Swelling from excess fluid in the lymph tissue, called lymphedema, can persist long after recovery from the cancer, noted the authors of the study, which was led by Dr. Armando E. Giuliano of the John Wayne Cancer Institute at St. John's Health Center in Santa Monica.
The findings add to a collection of studies that "have shown that less surgery combined with more radiation and chemotherapy have improved survival for women with breast cancer," said Dr. Grant Walter Carlson and Dr. William C. Wood of Emory University in Atlanta, the authors of a commentary accompanying the study.
Moreover, they said, because survival rates were so high at the five-year mark, it is unlikely that differences in the two groups' survival rates will arise at the 10-year mark or later.
"This is really a move toward less radical surgery" for breast cancer patients, Giuliano said.
Lymph nodes are tiny structures linked by a network of vessels throughout the body that are part of the disease-fighting immune system. When cancer spreads, it typically travels first to nearby nodes.
About a third of the women diagnosed every year with breast cancer have disease that has spread to the lymph nodes, the National Cancer Institute said.
Times wire services contributed to this report.