Some breast cancer patients can get less surgery

The big upside to sparing the lymph nodes is fewer adverse effects like arm pain, frozen shoulder, infections, and lymphedema, which is permanent swelling in the arm. Some 70 percent of the 446 patients who were randomly assigned in the study to have their lymph nodes removed developed such complications compared to 25 percent of the 445 patients who retained their lymph nodes.

"Lymphedema and quality of life become huge issues after breast surgery," says Dr. Mehra Golshan, director of breast surgery at the Dana-Farber/Brigham and Women's Cancer Center who was not involved in the study, "and it's a great thing to find that lymph node sparing surgery can provide the same shot at survival with fewer complications."

Golshan says he and his colleagues at the various Harvard hospitals decided last fall to offer the lymph sparing surgery to some women with one or two positive nodes after hearing the study presented by the researchers at a spring cancer meeting.

Until then, Harvard surgeons removed just a few nodes to see if they contained cancer and would only leave the rest of the nodes intact if that first node was cancer-free -- which has been standard practice in the U.S. for the past decade.

While the majority of cancer patients are diagnosed early before the cancer has spread to the lymph nodes, up to 20 percent have an early stage cancer with some lymph node involvement. Those who opt for lumpectomies with radiation, rather than mastectomies, can now be offered the lymph sparing surgery since the radiation could kill any cancer cells left in the nodes, Golshan says.

Oncologists at other Boston hospitals, however, may differ somewhat in how they change their practice as a result of the new finding. "This is exciting data, but it certainly doesn?t apply to everyone," says Maureen Kavanah, a surgical oncologist at Boston Medical Center.

She says oncologists at her institution often like to know the extent of lymph node spread to determine whether to use radiation on that area or to offer the option of an experimental treatment. Also, oncologists might be more willing to spare lymph node removal in those who have "estrogen-receptor" positive cancers that can be treated with anti-estrogen drugs like tamoxifen. These drugs could destroy any remaining cells in the lymph nodes.

And even with the new study finding, surgeons aren't comfortable leaving potentially positive nodes in women who had mastectomies without radiation -- since they weren't included in the study -- nor in those who have enlarged lymph nodes that can be felt on a physical exam.

A study now being conducted in Europe that involves 4,000 breast cancer patients will answer the question as to whether it's safe to spare cancerous lymph nodes in women who don't get radiation.

While doctors up-to-date on the latest research may be eager to spare patients unnecessary side effects, they may have a tough time convincing some women that it's okay to leave potentially cancerous lymph nodes in the body.

Golshan says he saw two patients yesterday who had a single positive node and early stage cancer. He offered both the lymph node sparing surgery but only one took him up on it.