Hopes for discovery
A RECENT medical study has promised good news for thousands of women whose breast cancer surgery might lead to a painful condition known as lymphedema.
This drastic and persistent arm swelling is a frequent consequence not of breast surgery itself, but of removing nearby lymph nodes.
But i t t urns out t he women in the study who kept their nodes, even if cancer was present, fared just as well as those who had them removed.
Still, will doctors and patients knowingly leave behind anything cancerous, even just a lymph node or two?
It will be a tough sell, a d m i t s D r P e t e r Blumencranz, director of Morton Plant Hospital’s C o mpr e h e n s i v e B r e a s t C a r e C e n t e r , i n Clearwater, Florida, and a co-author of the study, published in the Journal of the American Medical Association.
Leaving behind lymph nodes known to have cancer goes against physicians’ training and most c u r r e n t m e d i c a l guidelines.
‘‘ We had trouble recruiting patients for the study because surgeons were uncomfortable with the idea of not taking the nodes,’’ he said. Researchers hoped to enrol 1900 patients, but only about half that number signed up.
‘‘ What we were
asking them to do was radical,’’ he said.
For decades, doctors removed all lymph nodes f rom all breast cancer p a t i e n t s . L a t e r , r e - searchers found that only women with positive sentinel nodes ( the first nodes w h e r e b r e a s t c a n c e r typically spreads) had to have all their nodes removed.
Then in 1999, a group of p h y s i c i a n s , i n c l u d i n g Blumencranz, launched a study to find out if breast cancer patients with positive sentinel lymph nodes could be spared complete node removal.
The thought was that r a d i a t i o n a n d c h e mo - therapy would eradicate stray cancer cells in the lymph nodes. ‘‘ The good news is, after six years of follow-up, those women who kept their nodes did as well as those who had their other nodes removed,’’ Blumencranz said.
Dr Christine Laronga, program leader of the Don and Erika Wallace Comprehensive Breast Program at the H Lee Moffitt Cancer Center in Tampa, Florida, helped recruit patients and remembers the early days of the study. ‘‘ When doctors first heard about this study, everybody thought: Are you crazy?’’ she said.
But as results started trickling in and there was virtually no difference in outcomes, Laronga and others started offering select patients the option. RADICAL APPROACH: Studies have shown women who don’t have lymph nodes removed do as
well as those who do