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Fewer nodes to remove in breast cancer surgery

February 8, 2011 12:00:00 AM PST
Is less more when it comes to breast cancer surgery? A new study finds many women may not need a painful procedure that's become routine.

A week after surgery to remove two breast tumors, 74-year-old Shirley Vickrey's only complaint is about the lymph node removal that followed.

"I want to tell you that test was the worst part of the whole procedure, the sorest and the longest to heal," said Vickrey.

Breast cancer surgeons like Dr. Deanna Attai routinely remove one or two lymph nodes to see if the cancer has spread.

"If the pathologist in the operating room tells me that there's cancer in the sentinel node, I'm going to take the rest of the lymph nodes just because that's what we've always done," said Attai.

Vickrey's lymph nodes were fine. But if there was cancer, would removing a large number of nodes actually improve survival?

Researchers at several top medical facilities randomly separated about 900 patients with cancer-positive nodes into two groups.

Women who underwent the more aggressive procedure had on average 17 lymph nodes removed. Women who underwent the simpler procedure had two removed.

In both groups, the five-year survival rate and the risk of the cancer returning was nearly the same.

"If it's not going to change your overall survival and if it's not going to change the risk or further reduce the risk of the cancer coming back, then why subject the woman to more potential complications?" said Attai.

Women who have a large number of nodes removed are more likely to experience painful swelling and disability due to lymphedema.

Although all breast cancer cases are different, Vickrey feels this new information is reassuring news for all women.

"They have come such a long way that I think simpler is better," said Vickrey. "I think less is more very often."

Experts estimate about 20 percent of breast cancer patient meet the criteria for the less-radical procedure.

Researchers at Santa Monica's John Wayne Cancer Institute at Saint John's Health Center say removing cancerous nodes is not necessary because chemotherapy and radiation will wipe out the disease in the nodes, which can't be eliminated by surgery alone.