Axillary node dissection may not be needed for many women with early-stage breast cancer

Ten-year results from a major breast cancer clinical trial suggest that routinely removing the axillary lymph nodes during lumpectomy to remove early-stage breast cancer may not be necessary.

The study was published in the journal JAMA and examined nearly 900 women diagnosed with early-stage breast cancer to find out if axillary node dissection lead to better long-term outcomes.

The axillary lymph nodes are the lymph nodes under the arm. Surgically removing those lymph nodes is called axillary lymph node dissection and is often done if a sentinel node biopsy indicates the cancer has spread beyond the breast.

In this study, the women were split into two groups. All the women had a lumpectomy to remove the breast cancer, a sentinel node biopsy, and whole breast radiation treatment. Most of the women also had chemotherapy and hormonal treatment after surgery.

However, after radiation therapy one group had further surgery in the form of axillary lymph node dissection, while the other group had no more surgery.

After 10 years of follow-up, the researchers found no differences in survival between the two groups:

  • 86.3% of the women who had sentinel lymph node dissection alone were alive
  • 83.6% of the women who had axillary lymph node dissection after sentinel node dissection were alive.

Recurrence rates were also similar between the two groups:

  • 80.2% of the women who had sentinel lymph node dissection had no recurrence in the 10 years of follow-up
  • 78.2% of the women who had axillary lymph node dissection after sentinel node dissection had no recurrence in the 10 years of follow-up.

In the past, most doctors thought that axillary lymph node dissection made sense for many women diagnosed with early-stage breast cancer that had spread to nearby lymph nodes.

However, this study suggests that other treatments such as chemotherapy and hormonal therapy after surgery may make axillary lymph node dissection unnecessary for some women.

The results of this study only apply to women with early stage breast cancer in which there has been no evidence of enlarged lymph nodes. They do not apply to:

  • women with lymph nodes that are enlarged or suspicious based on a doctor's exam or testing before surgery
  • women who have had mastectomy with or without chemotherapy and radiation.

The American Society for Clinical Oncology has released guidelines on sentinel lymph node biopsy for people diagnosed with early-stage breast cancer.

The guidelines say:

  • Women with negative sentinel node biopsies should not have axillary node surgery.
  • Women with one or two positive sentinel nodes who plan to have lumpectomy plus radiation don’t need axillary node surgery.
  • Women who have one or more positive sentinel nodes and plan to have mastectomy with no radiation should be offered axillary node surgery.

For much more information you can read the study here: “Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial.”

31 Oct 2017

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