Breast-cancer treatment: When less can be more

Feb 9, 2011 5:12 PM

A new study finds that many women with early breast cancer don’t need to have lymph nodes in their underarms surgically removed, reversing standard practice. In the past, breast-cancer patients who had relatively small cancers that had spread to the first (or sentinal) lymph node in their underarm, but no further, would have all of the other nodes surgically removed, with the expectation that would prevent the cancer from spreading. The new study found that the procedure doesn’t improve survival or offer any other benefits. The finding applies to roughly 20 percent of breast-cancer patients.

The finding, published online today in the Journal of the American Medical Association, is good news, as it might allow those women to forgo a potentially painful procedure that can lead to complications, including infection and lymphedema, or swelling in the arm. And it’s part of a trend toward less aggressive treatment for breast cancer that started in the 1980s with a move away from radical mastectomy (the surgical removal of the entire breast plus the underlying muscle), to simple mastectomy (the removal of just the breast), to lumpectomy (the removal of just the tumor).

Aggressive surgery is no longer as necessary in part because of better additional therapies, such as radiation and chemotherapy, that can be combined with less-aggressive surgery. But part of it also stems from new research that has questioned certain accepted practices. Now it remains to be seen how doctors and patients adapt.

“Doctors and patients are often quick to embrace change when it involves using new drugs or new treatments, but are resistant when it comes to being less aggressive,” says Marvin M. Lipman, M.D., chief medical adviser to ConsumerReportsHealth.org. “But in fact, less aggressive care, especially when it avoids distressing complications or side effects, can often mean better care, as this study shows.”

In fact, we have long recommended that women diagnosed with early breast cancer resist the pressure to make quick decisions about their care.

—Joel Keehn, senior editor