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Breast Cancer Patients Can Be Spared Extra Surgery

Study Shows Removal of Additional Lymph Nodes May Be Unnecessary

Lymph Node Removal: One Size Does Not Fit All

Some doctors are already moving away from performing axillary lymph node surgery in older women and those with the tiniest cancerous growths in the nodes, says Thomas B. Julian, MD, of Allegheny General Hospital in Pittsburgh.

That's because modern drug and radiation treatments given to women after breast-conserving therapy are likely to kill off any cancer cells in the lymph nodes anyway, he says.

"These data give us a little more confidence that we don't have to remove [the axillary lymph nodes] in these women," Julian tells WebMD.

But for women with larger nodal growths -- and that's still pretty tiny, anywhere from 0.2 millimeters to 2 centimeters, or from ten-thousandth of an inch to about a tenth of an inch -- node removal is still standard and will probably remain so, Julian say.

"I don't think the word is in. We need more data," he says.

"For women with smaller metastases, a lot will come down to patient preference," Julian says.

About 25% of women who undergo breast-conserving surgery for early-stage breast cancer have positive sentinel lymph nodes, according to Julian.

Study Underpowered

One problem with the study is that the researchers only managed to enroll 800 of the 1,900 women originally intended.

Giuliano says it was "unlikely" the additional patients would have changed the findings, and several doctors asked by WebMD agree.  It does make it "harder to extrapolate the results," Julian says.

Julian's own research, also presented at the meeting, confirm that for women whose sentinel nodes are cancer-free, removing more lymph nodes from the underarm area is unnecessary.

This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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