Less Surgery for Breast Cancer is Being Studied

A procedure that would minimize the most debilitating part of breast-cancer surgery for most women is being studied by researchers at Baylor College of Medicine.

The procedure, known as a sentinel-node biopsy, removes only one or a few lymph nodes. The standard practice has been to remove most of the underarm, or axillary, lymph nodes during breast-cancer surgery. Two clinical trials are under way to determine if the new procedure is as effective as the current method.

Dr. Anthony Lucci, an assistant professor of surgery, and Dr. Richard Elledge, an associate professor of medicine, are principal investigators of the Baylor studies. The research, sponsored by the National Cancer Institute, is also under way at other sites.

"The underarm surgery, not the breast surgery, causes the most complications, so the sentinel-node biopsy would seem preferable to most women," says Dr. Elledge. "We're moving in the direction of less and less surgery for breast cancer."

Recovery time for the sentinel-node procedure would be much less.

Complications from a complete axillary lymph-node removal include a persistent burning sensation, infection, limitation of shoulder motion and lymphedema, swelling caused by excess fluid buildup.

"Lymphedema is the most feared complication of breast-cancer surgery," says Dr. Lucci.

The type of operations routinely performed for breast cancer has changed dramatically over the years, from radical mastectomy to procedures requiring much less surgery, he says.

"Radical operations do not improve outcome from breast cancer," he says.

The sentinel node is the first lymph node to which breast cancer is likely to spread. The physician can identify the sentinel node by injecting dye or using a low-level radioactive substance.

In Dr. Lucci's study, women who have a sentinel node that is positive for cancer will be divided into two groups. One group will have further surgery to remove the underarm lymph nodes, and the other will have no further surgery. Both groups will undergo systemic chemotherapy and radiotherapy to the breast.

Dr. Lucci says it is important for physicians to determine if prognosis is affected if only a very small number of cancer cells are found to have spread to a lymph node. This study will examine the effect of these tiny tumor deposits on prognosis and will look at bone marrow to determine if whether more information can be gained about breast-cancer outcome.

In Dr. Elledge's study, half of the patients will get the standard treatment of removal of the underarm lymph nodes and half will get the sentinel-node procedure. If the sentinel node is negative, there is no further surgery. If the sentinel node is positive, all the lymph nodes are removed.

"These studies are being done to find out if the sentinel-node procedure will result in the same outcome as our standard surgeries with fewer side effects," says Dr. Elledge. "If it proves to be as effective, 70 percent of women could avoid the most difficult part of breast surgery."

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©2006 Texas Medical Center

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