There was a flurry of media reports late today about a new study in the Journal of the American Medical Association (JAMA) that finds women with early breast cancer may not need to have surgery to remove cancerous lymph nodes under the armpit. The study was led by researchers at the John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, Calif.
For the study, researchers analyzed outcomes among a group of women who received either axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND). All women had early-stage breast cancer that had spread to a nearby lymph node and had received treatment that included lumpectomy and radiation therapy. Overall survival rates after five years were about the same in both groups.
The researchers say their results suggest that breast cancer patients, such as those in this study, do not benefit from the addition of ALND in terms of local control, disease-free survival, or overall survival, and that ALND may no longer be justified for certain patients. Below is a comment from Otis W. Brawley, M.D., chief medical officer:
“Important in the history of cancer research has been the refinement of the surgical treatment of breast cancer. This study and others like it may ultimately change the standard for breast surgery among women with breast cancer who have sentinel nodes that test positive for the disease. It may also lead to breast cancer treatments that cause less harm.
“Currently, women with breast cancer who also test positive for cancer in the sentinel lymph node often receive further surgery to remove twelve to eighteen lymph nodes; so-called axillary dissection. This procedure often causes lymphedema, restricted shoulder movement, and other disabilities. Axillary dissection has been done for past several decades to determine staging and prognosis for treatment planning. It has not been used as a treatment per se. This study is evidence that the surgery may not be needed.”.