Expert Q&A addresses new findings in treatment for early-stage breast cancer

A recent study published by the Journal of the American Medical Association (JAMA) revealed that women diagnosed with early-stage breast cancer may not need to have multiple lymph nodes surgically removed following diagnosis. The findings of this study will change the way that breast cancer is treated, resulting in less invasive surgery and fewer side effects for thousands of women and men each year.

Dr. Lidia Schapira, Assistant Professor in the Department of Medicine at Harvard Medical School, helps to explain the results of this study and what this news means for people facing a breast cancer diagnosis.

This research talks about people facing an “early –stage” diagnosis of breast cancer. Can you explain what this means and who, specifically, may not need aggressive lymph node removal?
The study, published by Giuliano in the February 9th issue of JAMA, enrolled women with breast cancer that was less than 5 cm, had no palpable lymph nodes in the axilla (enlarged nodes that can be felt in the area under the arm) and a sentinel lymph node biopsy that showed cancer in one or two nodes. This roughly corresponds to women who have Stage I or II breast cancer, which is considered early stage and associated with an excellent prognosis.
The women enrolled in this study agreed to be randomized, and either received further surgery to remove additional lymph nodes or no further surgery on their nodes. At a median follow up of six years, researchers did not find any difference in survival for women who had axillary nodes removed after the sentinel node biopsy when compared to women who had not had such extensive surgery.

Lymph node removal has been considered standard treatment for breast cancer for many years. What are the benefits of NOT removing lymph nodes?
Less surgery means a shorter surgical recovery and less chance of complications such as lymphedema, pain or restriction of motion.

What factors indicate that a person DOES need to have numerous lymph nodes removed?
The findings of this study apply only to women who would have been ‘eligible’ to participate in this clinical trial. Women with tumors that are larger than 5 cm, palpable nodes in the axilla (enlarged nodes that can be felt under the arm), were treated with a mastectomy and/or had three or more sentinel nodes with cancer should still have a full dissection (surgery to remove some or all lymph nodes).

How do these findings change the standard of care for people diagnosed with breast cancer?
These findings allow the patient and her doctor to discuss the extent of planned surgery in the axilla (area under the arm where lymph nodes are found). If a woman has a small primary tumor and plans to have a lumpectomy and then have radiation and she has no palpable nodes, she may ask her doctor to limit the amount of surgery in the axilla. They could agree, for instance, to perform a sentinel node biopsy first and if the number of involved nodes is two or less, to avoid further surgery.

How many people will benefit from this discovery?
Many women will benefit from this discovery since the majority of breast cancers are detected at an early stage.

Do these findings apply to other types of cancers (not just breast cancer)?

I know someone who was recently diagnosed with breast cancer. What questions should this person ask his or her doctor, to be sure that this new information is considered as treatment decisions are being made?
Women diagnosed with breast cancer who plan to have a lumpectomy and radiation need to discuss the plan for staging and treating the axilla with their surgeon prior to the procedure. If they fit the criteria we discussed earlier (small tumors and no palpable nodes) they could agree to do only a sentinel node biopsy and possibly avoid the dissection.

If only one or two sentinel nodes are found to be positive, it’s possible that they can agree not to proceed on to a full dissection (which requires an incision and more extensive surgery). It is really important, however, for the patient and surgeon to agree that if the surgeon finds there are visible or palpable nodes during the operation, then the axillary dissection (removal of some or all lymph nodes under the arm) should still be performed.

I have recently been diagnosed with cancer. If I don’t have numerous lymph nodes removed, is there a greater chance that my cancer will spread or come back?
Based on the results of this study, if you have two or fewer sentinel nodes, no visible or palpable disease in the axilla and receive radiation and appropriate ‘systemic’ therapy, your chance of having a recurrence will likely be the same if you have or don’t have additional nodes removed.

Thank you, Dr. Schapira, for helping us to better understand these findings!

Want to Know More?
This study and its implications will be discussed in greater detail on an upcoming episode of the Cancer Support Community’s internet radio show, Frankly Speaking About Cancer. Dr. George Sledge, breast cancer expert and pioneer in the development of new cancer therapies, will join guest host Ashley Varner for a discussion on what these findings mean for the breast cancer community at large. Breast cancer survivor Sharishta Shourie will also be on the show to voice questions and concerns from a patient perspective.

Be sure to tune in on Tuesday, March 8th at 4PM EDT for this candid discussion! This show and previously aired episodes can be found on the Frankly Speaking About Cancer show website.

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