Hopes for dis­cov­ery

Townsville Bulletin - - The Goss -

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

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