Lymph node removal for early breast cancer not essential? That s so last month!

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The top story in today’s The New York Times would have you believe that a new JAMA study showing that it may not be be necessary to remove the axillary lymph nodes in early-stage cases of breast cancer is the first report of its kind.

It seems that The Times didn’t get the memo last month when the New England Journal of Medicine published a similar study suggesting that the risks of the invasive procedure might outweigh its limited effect on survival — but we at ACSH thought it was big news then and appropriately addressed it in our January 20 Dispatch. Currently, when a biopsy reveals breast cancer cells in the sentinel lymph node, surgeons typically recommend removing nearby lymph nodes found in the armpit (axillary lymph nodes) in an attempt to hinder the spread of the cancer. However, both the January study, conducted by the Vermont Cancer Center, and the new JAMA study by Memorial Sloan-Kettering indicate that the survival rates associated with the radical lymph node removal surgery may be no greater than with chemotherapy and radiation alone. But lymph node removal can lead to painful and potentially disfiguring side effects such as lymphedema, which causes chronic swelling in the arm, as well as infections.

ACSH’s Dr. Elizabeth Whelan, however, reminds us that this finding does not apply to all breast cancer patients. As The Times article points out, only 20 percent of breast cancer patients with a positive sentinel lymph node biopsy would not benefit from current standard lymph node procedure. Even so, that percentage represents up to 40,000 U.S. breast cancer patients each year.

While The Times overlooked the importance of the nearly identical January findings, this new report makes it apparent that “we have at least two strong studies that show pretty clearly that for certain populations of women with small breast cancers, the survival benefit from radical lymph node removal is outweighed by lymphedema and other complications,” says ACSH’s Dr. Gilbert Ross.