Nodes Under Fire

Women with breast cancer know all about lymph node removal. Doctors routinely remove the axillary lymph nodes under the arm to see if the cancer has spread beyond the breast. Study finds, for most patients, the procedure has very little impact on their treatment or survival.

Sandra loves the active life, hitting the open road and going water-skiing, but she has to be careful with her right arm because of an operation. “I had 12 lymph nodes removed,” says Sandra.

Doctors routinely remove lymph nodes under the arm to see if breast cancer has spread. For patients like Sandra, it means having an arm that swells when it’s overused.

Sandra says, “You can get a big swollen hand and arm. It’s heavy, and it’s very painful.”

If it had a survival advantage, one would take it seriously. For a purely diagnostic procedure, however, this has a very high price.

A study by Dr. Parmigiani questions the usefulness of lymph node removal. He crunched numbers from clinical trials and found despite the results of the lymph node tests, treatment was similar for all patients. “The difference in survival is, at most, a matter of weeks,” says Dr. Parmigiani.

Some physicians, like Mark Yoffe, M.D., a medical oncologist at the Rex Hospital in Raleigh, N.C., aren’t ready to give up the procedure just yet. “In my own practice, I still use that data to decide sometimes what kind of therapy you’re going to utilize,” he says.

Some of the patients want nodes removed simply to know if the cancer has spread. Others think it’s time patients like Sandra fully discuss the advantages before mapping out plans for node removal.

Dr. Parmigiani says, “If we reach that, we will think we have done something useful for breast cancer patients.”

The study did find one group of women who were clearly helped by lymph node testing. Some women who are estrogen receptor positive and have small tumors may sometimes be able to avoid chemotherapy if lymph nodes are found to be clear of cancer.