DURHAM, NC -- Duke University researchers report that a common surgery used to determine the extent of disease in early stage breast cancer patients may not benefit a large number of them.
Axillary lymph node dissection, the removal of underarm lymph nodes that drain fluids from breast tissue, has been a mainstay of breast cancer treatment. Physicians used the findings to plan treatments based on whether the cancer had spread to the nodes, and to how many of the nodes. In fact, a patient's "stage" of disease depends in part on the findings.
But the Duke researchers found that information gained from this surgery, which often leaves a patient with scars and nerve damage, is not always crucial, given new ways of combating breast cancer. Knowing lymph node status was also unlikely to affect survival, they concluded in a study published in the May issue of the Journal of Clinical Oncology.
"Patients with positive nodes used to be treated differently than patients with negative lymph nodes," explained study author Giovanni Parmigiani, associate professor in the Institute of Statistics and Decision Sciences at Duke.
"Lately, research has been changing the recommendations for adjuvant therapy. If the information obtained through axillary lymph node dissection isn't as valuable for these patients, we should seriously consider reassessing its purpose."
Supported by the Duke Specialized Program of Research Excellence (SPORE) in
Breast Cancer award from the National Cancer Institute, the research team
developed a decision model to systematically evaluate axillary lymph node
dissection in early stage breast cancer patients whose nodes were normal on
physical exams. The researchers combined the results of numerous recent
clinical trials along with information about cancer rates and survival to
determine what benefit lymph node status provided. The results were quantified
in terms of additional life expectancy, taking into account quality of life
Contact: Joanna Downer
Duke University Medical Center