2011 Annual Report: Breast Cancer Surgery: Practice-Changing Findings for Some Patients

     

Although there has been much progress in cancer surgery over the past several decades, one practice has gone largely unchanged: For more than a century, women with breast cancer that has spread beyond the breast have been undergoing a potentially debilitating and painful procedure in which all the lymph nodes in the armpit are removed.

But a 2011 multicenter study, of which the Chief of Memorial Sloan Kettering’s Breast Service was the senior author, found that for women who meet certain criteria, the surgery, called axillary node dissection, is unnecessary and does not improve survival or reduce rates of recurrence. The majority of women who meet these criteria — about 40 percent of all breast cancer patients — have chemotherapy and/or hormone therapy such as tamoxifen, which is part of the standard treatment for breast cancer when there is any lymph node involvement.

Avoiding the removal of all their armpit nodes allows women to avoid the often severe side effects associated with the procedure. The most common is lymphedema, or swelling of the arm, which can be permanent and can greatly affect quality of life. The surgery can also lead to temporary or permanent loss of arm strength and difficulty with movement and is associated with a longer and more painful recovery after surgery. Changing the standard treatment will allow up to 40,000 women in the United States to avoid these side effects each year.