Drs. Carlson and Wood Co-Author Editorial Accompanying Dramatic Lymph Node Study

February 2011

According to "Axillary Dissection vs. No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis," a new study published in the February edition of Journal of the American Medical Association, the standard practice of removing cancerous nodes, a painful measure that can cause complications, does not improve survival or prevent cancer recurrence for about 20 percent of breast cancer patients.

Lead author Dr. Armando Giuliano (chief of surgical oncology at Saint John's Health Center in Santa Monica) and his colleagues analyzed data collected from 445 women who had their nodes removed and 446 who did not. Of course, all had radiation and chemotherapy. The researchers found no significant difference in the patients' chances of surviving five years after their diagnosis, with those who did not have the more aggressive surgery having a five-year disease-free survival rate of 83.9 percent compared to an 82.2 percent rate in those who did have the surgery. The researchers concluded that removing cancerous lymph nodes was unnecessary because chemotherapy and radiation had the ability to wipe out any disease in the nodes.

In an editorial accompanying the study entitled "Management of Axillary Lymph Node Metastasis in Breast Cancer: Making Progress," Dr. Grant Carlson and Dr. William Wood called the study an "important contribution" that represents the latest development in breast cancer treatment, which has steadily been moving toward less-aggressive options, sparing women from unnecessary surgery and follow-up therapy. "Women with breast cancer have benefited greatly from a series of carefully performed randomized controlled trials," they wrote, that "have shown that less surgery combined with more radiation and chemotherapy have improved survival for women with breast cancer."  According to Drs. Carlson and Wood, the study provides "strong evidence that patients undergoing partial mastectomy, whole-breast irradiation, and systemic therapy for early breast cancer with microscopic SLN (sentinel lymph node) metastasis can be treated effectively and safely without ALND (axillary lymph node dissection)."

Experts predict that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. For example, various media outlets have reported that Dr. Gary Lyman of the American Society of Clinical Oncology has said that the group will probably be prompted to revise its recommendations for breast cancer patients accordingly. The guidelines are currently under review by the panel that issues them.