‘No lymph node removal for early breast cancer’

A new study finds that many women with early breast cancer do not need a painful procedure that has been routine: removal of cancerous lymph nodes from armpit.

The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping the cancer from spreading or coming back.

Now, researchers report that for women who meet certain criteria — about 20 per cent of patients, or 40,000 women a year in the US — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphoedema, a chronic swelling in the arm that ranges from mild to disabling.

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in nodes, researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realisation that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.

The study, at 115 medical centres, included 891 patients. Their median age was mid-50s, and they were followed for a median of 6.3 years. The study, which is being published Wednesday in The Journal of the American Medical Association, was paid for by National Cancer Institute.

The new findings are part of a trend to move away from radical surgery for breast cancer. Rates of mastectomy, removal of whole breast, began declining in 1980s after studies found for many patients, survival rates after lumpectomy and radiation were just as good as after mastectomy. The modern approach is to cut out obvious tumours — because lumps big enough to detect may be too dense for radiation to destroy — and to use radiation and chemotherapy to wipe out microscopic disease in other places. But doctors continued to think that even microscopic disease in lymph nodes should be cut. And till recently, they counted cancerous lymph nodes to gauge severity of disease and choose chemotherapy.