It is fascinating how medical knowledge progresses. For 40 years the surgical wisdom has been to take the sentinel node and if it shows any cancer cells, keep removing the lymph nodes until they are totally clear and/or all of them in any event. Terrible morbidity resulted for so many women - usually lymphodema ie., the massive swelling of the affected arm and affected side of the body. The pressure and ongoing pain as well as the management of what is normally a small issue such as a cat scratch or a rose thorn scratch assumed massive proportions. Today JAMA [Journal of American Medical Assoc] published research showing remomal of lymph nodes in early stage breast cancer has zero effect on overall survival. What does this mean for TO and T1 breast cancer patients? Removing our lymoh nodes - even in cases where there are changes in them - does not make us live longer in the majority of patients. This means most women in these categories are are having lymph node removal as a precaution when in the majority of them, it makes no difference to how long we live. In other words, serious over treatment. I believe equally that there are early stage breast cancer patients in whom radiation therapy can be omitted and for the same reasons - it is associated with morbidity and the medical profession have been as slow to research the no radiation option for early stage breast cancer sufferers as they have been for the past 40 years with no lymph node removal. There is a research lacuna and because of this research gap, the option was for lymoh node dissection [one, some or all] for most early stage breast cancer patients.
Now, post the JAMA study, some women with early stage breast cancer will continue to opt for more than one, many or all axillary dissection and therefore opt for the risking the morbidity that can result. Others will opt for much less lymph node removal based on this study and their personal assessment of the risks versus benefits.
Yet as of today, the lymmph node removal constitutes over treatment when the end result is considered to be its effect on our overall survival rates - but some women want to know they have tried everything.
The fact is over treatment with lymph node dissection has been "the norm" or standard medical treatment for the past 40 years in most western countries and as of today, it no longer represents the optimal standard of care for the sub set of breast cancer patients with early stage breast cancer.
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It is fascinating how medical knowledge progresses. For 40 years the surgical wisdom has been to take the sentinel node and if it shows any cancer cells, keep removing the lymph nodes until they are totally clear and/or all of them in any event. Terrible morbidity resulted for so many women - usually lymphodema ie., the massive swelling of the affected arm and affected side of the body. The pressure and ongoing pain as well as the management of what is normally a small issue such as a cat scratch or a rose thorn scratch assumed massive proportions. Today JAMA [Journal of American Medical Assoc] published research showing remomal of lymph nodes in early stage breast cancer has zero effect on overall survival. What does this mean for TO and T1 breast cancer patients? Removing our lymoh nodes - even in cases where there are changes in them - does not make us live longer in the majority of patients. This means most women in these categories are are having lymph node removal as a precaution when in the majority of them, it makes no difference to how long we live. In other words, serious over treatment. I believe equally that there are early stage breast cancer patients in whom radiation therapy can be omitted and for the same reasons - it is associated with morbidity and the medical profession have been as slow to research the no radiation option for early stage breast cancer sufferers as they have been for the past 40 years with no lymph node removal. There is a research lacuna and because of this research gap, the option was for lymoh node dissection [one, some or all] for most early stage breast cancer patients.
February 14, 2011 - 1:39amNow, post the JAMA study, some women with early stage breast cancer will continue to opt for more than one, many or all axillary dissection and therefore opt for the risking the morbidity that can result. Others will opt for much less lymph node removal based on this study and their personal assessment of the risks versus benefits.
Yet as of today, the lymmph node removal constitutes over treatment when the end result is considered to be its effect on our overall survival rates - but some women want to know they have tried everything.
The fact is over treatment with lymph node dissection has been "the norm" or standard medical treatment for the past 40 years in most western countries and as of today, it no longer represents the optimal standard of care for the sub set of breast cancer patients with early stage breast cancer.
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