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    Study: Lymph node removal not always needed for breast cancer patients

    By Lylah M. Alphonse, Senior Editor, Yahoo! Shine | Work + Money – Wed, Feb 9, 2011 8:56 PM EST

    A study published today in the Journal of the American Medical Association finds that as many as 20 percent of women with breast cancer may be able to skip the painful surgery to remove infected lymph nodes under their arms, avoiding complications like lymphedema without harming their health.

    The news is "very exciting," says Dr. Mehra Golshan, director of breast surgery at the Dana-Farber Cancer Institute in Boston. "It is practice-changing in many respects."

    Until just a few decades ago, a breast cancer patient's primary option was a radical mastectomy, the removal of the entire breast and surrounding tissue, including the lymph nodes in the armpit. In the 1980s, studies showed that lumpectomies, which targeted just the tumors and spared much of the breast, worked well for many patients when coupled with radiation therapy.

    Being able to retain the lymph nodes "is really a move toward less radical surgery" for breast cancer patients, study author Dr. Armando Giuliano, cancer surgery chief at the John Wayne Cancer Institute in Santa Monica, California, told the Associated Press.

    During a lumpectomy, a few of the guardian or sentinel lymph nodes are removed and tested for cancer, explained Dr. Golshan, who was not a part of the study. Until now, if cancer was detected in even a single sentinel node, all of the axillary lymph nodes (the ones inside the arm pit) were removed. The idea was to stop the spread or recurrence of cancer, but the procedure often caused long-term complications, including numbness, loss of mobility, infection, and lymphedema-a chronic, incurable swelling of the arm.

    The JAMA study involved about 900 women and found that, a little more than six years after treatment, overall survival rates were virtually identical for women who had retained their axillary lymph nodes (92.5 percent) and those who had theirs removed (91.8 percent). The disease-free survival rate was 83.9 percent for those who did not have their lymph nodes removed, and 82.2 percent for those who did. So, for breast cancer patients who meet the same criteria as those in the study, removing all of the axillary lymph nodes is not necessary-and keeping them could make for a better quality of life.

    Women who undergo lumpectomies are normally also treated with chemotherapy or hormone-blocking drugs and radiation that targets the whole breast and part of the armpit. The study shows that this additional treatment may be enough to destroy cancer cells in any remaining lymph nodes. The study did not consider outcomes for women who do not have radiation or chemo, or for those who only have radiation applied to part of their breast; it is also not known whether the findings would be the same with other types of cancer. The median age of patients in the study was the mid-50s.

    If you've recently been diagnosed with breast cancer, you and your medical team may be wondering how the JAMA study affects you. We turned to Dr. Golshan of Dana-Farber Cancer Institute for answers to some of the big questions:

    How does a woman (and her doctor) know if she meets the study's criteria and decide whether forgoing lymph node removal is an option?

    Women with early stage (T1 or T2) breast cancer, with tumors less than 5 centimeters (2 inches) in size, with cancer detected in just one or two sentinel lymph nodes, are the best candidates for avoiding the removal of additional the axillary lymph nodes, says Dr. Golshan of Dana-Farber. According to the study, about 20 percent of breast cancer patients-as many as 40,000 women per year in the United States-could qualify.

    Are there any patients who should have their axillary lymph nodes removed anyway?

    Women who chose or needed a mastectomy would still need to have their axillary lymph nodes removed, Dr. Golshan says, as would anyone whose cancer has already "burst through lymph nodes" or whose tumors, when removed, do not have a margin of clear, cancer-free breast tissue around them. "It's a very personal decision, just like breast conservation therapy and mastectomy," Dr. Golshan points out. "Some patients will decide that they should have it."

    What are the benefits to avoiding lymph node removal?

    Dr. Golshan notes that if the patient is undergoing a lumpectomy, the breast conservation and post-op treatment stay the same whether she has the axillary nodes removed or not. But if the axillary nodes are not removed, recovery is quicker, infection rates are lower, and while the patient still could develop lymphedema, the risk is much lower: 2 percent to 5 percent, as opposed to as high as 25 percent. "The lymphedema rates are not zero," Dr. Golshan says. "It's just a lot less." You also regain full range of motion much more quickly after surgery and, unlike patients who have had their axillary lymph nodes removed, you can still use the arm for blood pressure readings and blood draws. Lymphedema has no cure, though physical therapy can help in some patients.

    What could the study mean for breast cancer treatment in general?

    Dr. Golshan cautions that there are still some concerns. Many cancers were hormone-sensitive, and those types of cancers can take more than a decade to recur, but the study only followed women for a little more than six years. "We don't know if things may change a little bit farther down the road," he pointed out.

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    31 comments

    • BCS
      BCS  •  1 year 3 months ago
      As an eleven-year breast cancer survivor, I disagree with this article.
      I had chemotherapy before my modified radical mastectomy (my choice), and they still found cancer in one of the twelve lymph nodes they removed during my surgery.
      IT'S NOT WORTH YOUR LIFE TO TAKE THE CHANCE!!!
    • Laurie
      Laurie  •  1 year 3 months ago
      Lymphedema is a chronic condition but there are ways to combat it and help a person to reduce and control the edema. It's a treatment technique call Complete Decongestive Treatment. It consists of manual lymph drainage massage, multi-layered compression bandaging, patient education and fitting the patient with compression garments to help contain/control the edema. For more information contact the National Lymphedema Network. They have a listing of Certified Lymphedema Therapists-a therapist having at least 120-135 hours of special training to learn about the lymphatic system and treatment techniques. They have state by state treatment facilities listed and articles on the latest in lymphedema treatment. Go to www.lymphnet.org
    • Dusty
      Dusty  •  1 year 3 months ago
      the least invasive.
      When I had my scare awhile ago I got another opinion who ordered further testing which
      showed while irregular the cells were NOT cancer.................
      My doctor concurred telling me the body has numerous irregular cells but that does not mean
      they are all cancer...........
      The first doctor I saw was knife happy, not even willing to further test.
    • Katie
      Katie  •  1 year 3 months ago
      This article couldn't have come at a better time. My lumpectomy is Monday. Thank you to Yahoo for posting it!
    • Michael
      Michael  •  1 year 3 months ago
      Grateful Child, Bogard is not wrong and you need to hear from the many (not all) cancer patients how they are being coerced into the radical treatments which really leave them feeling worse from the treatments rather than the cancer and oftentimes one round of treatment is not enough and they put them through more like making use of them as guinea pigs. I shall not elaborate but suffice to say that the medical personnel you speak highly of are trained in that direction and that direction only. So much more GOOD and WHOLESOME treatments which respect the human body and dignity are out there. Again, I shall not elaborate but anyone with a keen interest in going the natural way can easily find out. They are not fads or hocus-pocus as the medical establishment would have you think. Generally, it is the pharmaceutical industry which is running the whole show. So, it is also about the money, sorry to say.
    • Ilia I.
      Ilia I.  •  1 year 3 months ago
      What about post surgery lymphodeme after the removal of a lymph node due to lymphome cancer found in right femur? Today, after 29 years ago, I am disable from my right leg, acute lymphodeme. Stopped me from regular daily activities, including work. What compensation can be offered in my case?
    • nomore
      nomore  •  1 year 3 months ago
      I thought lymph biopsy is to determine how far the tumor has gone, not the treatment. The primary surgery is to remove the source of cancer and hope it hasn't gone anywhere.
    • Mariela Z
      Mariela Z  •  1 year 3 months ago
      Wow. My mother had lymphedema on her arm after her masectomy. She passed away 3 years ago from breast cancer.
    • Crazycreekwoman
      Crazycreekwoman  •  1 year 3 months ago
      My daughter has lymphedema but no signs of cancer. It started in the left leg and now other leg and stomach. Is there any way this surgery would work for someone with this problem.
    • robine
      robine  •  1 year 3 months ago
      I guess with all the information that has come out it has become safe to say...breast cancer is terminal. Right...? Women have been told five years and they were out of the clear. Now, with "new studies" women who felt safe and have regained life after being sliced and diced can now feel threatened again. Wow...thanks. I am so glad that the power of prayer is so alive and that there is the power of healing. Otherwise, all of us women who have been diagnosed would be walking under an umbrella of doom and at the mercy of the medical field for the rest of our lives. Thank God for God He never fails us.
    • Vanessa
      Vanessa  •  1 year 3 months ago
      Be prepared - this is only the beginning. With the new Health
      Care Laws - you will find a lot of things that are being eliminated.
      Remember recently, the article about not having what THEY
      called aggressive treatment for the elderly. This is not ONLY
      for the elderly, as you are now seeing, all of a sudden, since
      the Gov't is becoming involved in health care, you will find a
      lot of things are being eliminated. The more items eliminated
      the quicker you CAN die and get off the gov't bandwagon. This
      will not ONLY be for the elderly - it will be for everyone. It
      sounds great - that a pre-existing condition can not be turned
      down for care, but what they are NOT saying, they will know
      exactly WHAT is wrong, do as little as possible, and help
      eliminate a lot of government money drain of taking care of
      people........keep watching - see all of the OTHER things
      they suddenly discover - that is NO LONGER NEEDED.
      Age is not taken into accountability......its anyone. As
      each pre-existing condition hits - you will find changes
      in its care....... Don't believe this - continue to watch.
    • Grateful Child
      Grateful Child  •  1 year 3 months ago
      Bogard, ...shame on you. Most doctors, nurses, and medical professionals have their heart into their work. I commend them and the service they do for others.
    • Grateful Child
      Grateful Child  •  1 year 3 months ago
      Please deliver farm fresh veggies to you local oncology treatment center. Our bodies need the proper nutrients to be able to help themselves, ...what you won't find in a supermarket. Farms for Hope is a new website I'm creating to encourage others to help.
    • A J
      A J  •  1 year 3 months ago
      Best to stop the cancer before it starts-
      1) Don't smoke. It disables gene repair and doses you with carcinogens.
      2) Don't eat meat, chicken and fish. This doses you with carcinogenic heterocyclic amines, makes you depressed, makes people more violent and causes osteoporosis.
      3) Eat a lot of dark leafy greens.
    • AmericansFirst
      AmericansFirst  •  1 year 3 months ago
      What about the procedure of Dr Chen at the University of Central Oklahoma! He received national recognition for it and last I heard it was refined for skin and breast cancer ! His method took a biopsy sample of the cancer which he modified and reinjected and anyplace place it found the cancer in the body it destroyed it after it had migrated ! If it were me I would try it out along with conventional treatment !
    • su
      su  •  1 year 3 months ago
      i've been waiting for this article.please feed us with the likes. we don't need the 'how to groom your dog' thing.
    • TamiN
      TamiN  •  1 year 3 months ago
      While I am greatful for medical advancement...I am angry for losing my mother 2 years ago after she had a double masectomy.
    • think
      think  •  1 year 3 months ago
      This is really tasteless, and I have to admit the obvious, however, whatever it takes to prevent breast problems for the lady in the picture should be done at all costs. Please, for the sake of all women, don't let anything happen to hers. Great choice for getting attention. Sorry, I told you it was tasteless.
    • Oceania
      Oceania  •  1 year 3 months ago
      The ONLY test that should be used for checking lymph nodes and breasts is a MMR and nothing else because in numerous cases it turned out they were Fibroids and were not cancerous. In the 1960's the medical field was thrilled with doing massive hysterectomies, unecessary ones.

      In some cases, yes this is the ONLY resort and will save your life, but get a MRI (NOT A MAMMOGRAM)and a second opinion before you allow any unecessary surgery done on you.

      I had maligant melonoma and I had only enough money to get it taken out (and paid for the lab tests that showed it was malignant). The large hole in my arm finally filled in later and the cancer has never returned and I had nothing else done. It has been over 20 years.
      Having cancer is not a death sentence, timing is what is critical. Best of health to everyone.
    • Dubby
      Dubby  •  1 year 3 months ago
      It's a shame that doctors are just now figuring this out when the symptoms have been around for a a while. My mother was just diagnosed with breast cancer last April and they took out all of her lymph nodes leaving her with lymphedema. The swelling in her arm and side of her breast is practically constant, and she is almost always in pain. Only one positive lymph node was found out of all of them, so the procedure wasn't necessary at all, but now she'll have to live the rest of her life with this troublesome side affect.
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