Study tests methods of stopping early breast cancer

February 8, 2011 3:11:34 PM PST
Surgery to remove the tumor is an important part of stopping early breast cancer.

But there's usually an additional procedure that can be either extensive or minimal.

A new study compares the two procedures in terms of survival.

With early breast cancer, small tumors are usually removed with a lumpectomy, but then there's the additional procedure to check spread into the lymph nodes.

It's a surgery already offered in many hospitals.

After removing a tumor from a woman's breast, they will remove and test only one or two of the surrounding lymph nodes. It's called sentinel node biopsy.

The alternative had been a more radical surgery to remove a bigger number of lymph nodes.

In the study, rates of survival and of patients' remaining cancer-free were just as good whether the women with limited spread - in one or two nearby nodes - had lots more underarm nodes removed or skipped that major surgery.

Bobbie Saunders had the lesser surgery.

"I had already experienced a lot of people that had been through the radical, so I was really excited that I was offered this," she 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.

The study refutes previous research suggesting a greater chance for recurrence when cancer is found in one or two nodes.

The difference may be the overall treatment given to the women in the study.

"Removing fewer lymph nodes results in less pain, less morbidity. It's an outpatient procedure compared to an auxiliary node dissection, which typically results in a one or two day hospitalization," Armando E. Giuliano, M.D. of the John Wayne Cancer Institute said.

Giuliano led a randomized clinical trial comparing the two procedures.

The study involved about 850 women who had initial biopsies showing cancer had spread to one or two nearby lymph nodes.

About half of the women were randomly assigned to receive the more invasive node surgery; the remainder skipped that surgery.

"The five year survival was about 92 percent regardless of which operation and wonderfully women who had the sentinel node biopsy alone did just as well as the women who had the more radical operation," Giuliano said.

Roughly 83 percent in both groups had no cancer recurrence. Seventy percent of women in the surgery group had complications, including underarm swelling and wound infection, versus 25 percent in group that skipped it.

Researchers say the comparable survival rates points to the effectiveness of the lesser surgery combined with additional treatments.

"We may be able to treat breast cancer even though it spread to the lymph nodes with less radical surgery and achieve the same results that we've been achieving with the more radical operation," Giuliano said.

It's an operation that has meant equal benefit, but less pain for bobby.

"I didn't have any stiffness or aches or pains. It was great," she said.

The study is published in Wednesday's Journal of the American Medical Association.

Choosing the right surgery for any breast cancer patient means getting the right information for her own case. Not every woman would be a candidate.



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