Less-severe surgery helps breast cancer patients

SAN ANTONIO — Removing just one to three key lymph nodes instead of the usual dozen or more can spare women lifelong arm problems and reliably indicate whether breast cancer has spread and needs aggressive treatment, the first big study to test this approach has found.

Many doctors have been doing this without proof that it is as good as the standard operation, and they still don't know whether it will hurt women's survival odds.

But the large, federally funded study has answered at least the accuracy question, finding that the less severe surgery is 97 percent accurate at revealing whether cancer has spread beyond the breast.

"There is a high degree of accuracy here," said Dr. Thomas Julian, a breast cancer surgeon at Drexel University College of Medicine and Allegheny General Hospital in Pittsburgh. "This offers an option for the majority of women."

He presented the research Thursday at a breast cancer conference in Texas.

Dr. Stephen Edge, a surgeon at Roswell Park Cancer Institute in Buffalo, N.Y., called it "a landmark study that many of us, including me, thought was undoable," because so many women already demand the less severe surgery.

When a woman has breast cancer surgery, doctors typically remove a third of the lymph nodes in her arm — about 10 to 20 — to see if the cancer has spread. The answer determines whether she needs further treatment with chemotherapy and radiation.

But the surgery leaves many women with motion problems and less feeling in their shoulder and arm, and up to 20 percent develop lymphedema, painful and severe swelling that can recur throughout their lives. They are also at greater risk of infection because they have lost so many lymph nodes that drain fluid from the arm.

"Patients often get caught by friendly fire," suffering ill effects from a procedure intended to help save their lives, said Dr. Mark Kissin of the Royal Surrey County Hospital in Gilford, England.

The alternative is called sentinel node biopsy. At the time of a woman's breast cancer surgery, doctors inject a dye that travels and collects in the lymph nodes most involved in draining the area nearest the tumor. The theory is that these "sentinel nodes" would be most likely to contain malignant cells if the cancer had spread beyond the breast.