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Less Surgery for Breast Cancer


A recent large study by the American College of Surgeons finds that women with small/intermediate size breast tumors who underwent breast conserving surgery (lumpectomy) and were found to have spread of cancer to their armpit lymph nodes did equally well with and without a full resection of all armpit lymph nodes. For years the dogma has been”, says Dr. Marty York, “that no cancer can be left behind”. He goes on the explain “when women have no spread to the lymph nodes by physical exam there is a 25% chance the lymph nodes will turn up with cancer at the time of surgery.” Surgeons typically first remove the sentinel lymph node (SLN) (could be more than one) and if that has cancer they then proceed to remove the rest of the lymph nodes. The problem with this type of surgery is that it often results in chronic pain and swelling of the arm (lymphedema) and the recuperation is longer than just having the SLN removed. This large study showed that removing the extra lymph nodes in those who had a cancerous SLN did not offer any extra benefit in terms of cancer recurrence locally or anywhere else in the body. Dr. York cautions that “these results will most probably change what we do for a lot of women with breast cancer but should be applied only to those whose treatment plan matches the one studied: women with tumors < 5 cm with normal lymph nodes by physical exam who then turned out to have an involved SLN biopsy”. After surgery all these women went on to receive radiation therapy as well as chemotherapy and/or hormonal therapy, at the discretion of their physician. “It would appear that radiation and chemo/hormonal therapy are the reasons that less of a surgery allows women to maintain high cure rates.” Dr. York concludes “this is something women facing breast surgery for cancer should definitely discuss with their surgeon before their surgery. Many stand to benefit from a smaller surgery.”



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