Expert Commentary

Removal of lymph nodes in women with invasive breast cancer

2010 study indicating that surgical removal may not be necessary for women with certain kinds of early-stage breast cancer.

For decades, women with early diagnoses of breast cancer have been encouraged to have the lymph nodes beneath their arm pits surgically removed. Draining the lymph nodes often precedes the surgery, which is then followed by radiation treatment. While painful and fraught with potential complications, removal of the lymph nodes has been standard practice in the medical community.

A 2010 study published in the Journal of the American Medical Association, “Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis,” calls into question the standard treatment for women with certain kinds of smaller, early-stage breast cancer tumors. Overall, the findings apply to 20% of women with breast cancer who meet certain criteria.

The study randomly assigned half the 856 participants to undergo the traditional three-step lymph-node treatment and the remainder to go through the draining and radiation, but forgo surgical removal. The study was motivated by the significant risk of negative side-effects associated with the surgery.

The study’s findings include:

  • The full three-step process, including surgical removal, did not produce superior statistical outcomes relative to just draining the lymph nodes and employing radiation.
  • For the group that underwent the full, standard procedure, the average five-year survival rate was 91.8%. For the group that did not undergo surgical removal of the lymph nodes, the survival rate was 92.5%.
  • The rate of cancer recurrence in the group that omitted the step of surgical removal was 2.5% compared with 3.6% for the group that underwent surgery.

Tags: cancer

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