NYT: Lymph Node Dissection Unnecessary

Janeluvsdogs

Oh dear...

http://www.nytimes.com/2010/06/08/health/08canc.html?ref=health  

 The study presented here involved 991 women who had had lumpectomies, radiation therapy and a positive sentinel lymph node. Half had the other lymph nodes removed and the others did not.

After five years there was no difference in survival or disease recurrence between the two groups. Some 82.2 percent of the women who had the dissection were alive and disease free compared with 83.8 percent of those who did not. Cancer recurred in the breast or nearby in 4.3 percent of those who had the operation and 3.4 percent in those who did not.

"The evidence is overwhelming that the operation might not be necessary," the lead investigator, Dr. Armando Giuliano of the John Wayne Cancer Institute in Santa Monica, Calif., said.

Luah

Thanks for posting, I'm glad to see some new research being done in this area.

Seven months ago, I struggled with the decision to get an ALND and dug up a lot of studies, for and against. At the time, both my BS and rad onc admitted that the surgery was likely to become less and less common.  But it is still standard of care right now (which can affect eligibility for clinical studies), and it does help in staging - even if not germane to treatment decisions as most women with a positive node will go on to chemo anyway. 

It should be noted too that radiation to the node area, like surgery, is also a risk factor for lymphodema. 

LtotheK

I found this both fascinating, and disheartening.  It's so difficult, accepting that our treatments may be significantly less invasive in the future.  But for now, we just can't take the risk.  As one gal on here already said, "I already blew the statistics by getting this in the first place.  Even 1% difference is big to me."

vespersparrow

I am currently in the decision process for my treatments, and I recently had a lumpectomy but refused the ALND against my surgeon's wishes (who promises the cancer will return).  Time will tell for me.  Developing lymphedema seems worse to me though than dealing with a local recurrence, especially since there's no clear survival advantage to preventing that with ALND, but this gives me hope that I may not have significantly worsened my chances.  I already did neoadjuvant chemo so I have no further need of staging information.

These sorts of decisions are extremely difficult.  I wish everyone the best with whatever path they choose.