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Breast Cancer Health Center

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Breast Cancer Patients Can Be Spared Extra Surgery

Study Shows Removal of Additional Lymph Nodes May Be Unnecessary
WebMD Health News
Reviewed by Laura J. Martin, MD

June 9, 2010 (Chicago) -- For many women with early-stage breast cancer, removing more than just the sentinel lymph nodes may be unnecessary -- even if cancer cells are found.

Breast cancer patients whose cancer has spread to the sentinel lymph nodes live just as long regardless of whether additional underarm (axillary) lymph nodes are removed, researchers report.

If cancer cells spread from a breast tumor, the sentinel nodes are normally the first place they go. Doctors can find the sentinel nodes and remove them with a small surgical procedure. If no cancer is found, removal of the remaining lymph nodes is not necessary.

When cancer is detected in the sentinel lymph nodes, American Society of Clinical Oncology (ASCO) guidelines, which most doctors follow, call for surgical removal of more lymph nodes under the arm to look for additional cancer cells. The procedure is called axillary node breast dissection.

"Our findings suggest that there may not be a benefit to removing more lymph nodes, and that women can avoid the risk of additional side effects that come with more extensive lymph node removal," says study head Armando E. Giuliano, MD, director of the John Wayne Cancer Institute Breast Center in Santa Monica, Calif.

Those side effects include pain, lost sensation, discomfort, and swelling (lymphedema) of the affected arm that can last for years, even decades.

Giuliano presented results of what he called the largest late-stage phase III study of axillary node dissection for sentinel node-positive women to date at ASCO's annual meeting.

No Benefit to Additional Surgery

The study involved 991 women who had lumpectomy, radiation therapy, and positive sentinel nodes. They were randomly assigned to have no more nodes removed or to have 10 more nodes removed.

By five years later, women who didn't have any more nodes removed were doing just as well on every measure:

  • 92.5% were alive vs. 91.9% who got additional surgery.
  • 83.8% were free of cancer vs. 82.2% of the additional-surgery group.

All of the differences could have been due to chance, the researchers say.

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