When you hear the words “You have cancer,” your life changes – instantly.
All of a sudden, you’ve crossed a line: the “cancer divide.” You’ve joined the hundreds of thousands of Americans who are battling this wretched disease.
Some of us live; some of us die. And all of us are marked by the experience for life.
Cancer comes with a centuries-old, ugly reputation. For hundreds of years, the chief weapon against solid-tumor cancers has been the knife.
Isolate the tumor; cut it out. Find out where it’s spread; do some more cutting. Surgically obliterate all traces of cancer, and only then move on to adjuvant therapy: chemo, radiation, drugs.
Surgery as the first bastion of defense for a particular group of cancer patients took a huge hit this week, however, when the Journal of the American Medical Association reported results of a study involving breast cancer survivors.
It appears that surgically removing all traces of cancer might not make the difference in recurrence and survival rates doctors have always believed it does.
Here’s the story. Back in 1999 researchers enrolled nearly 900 women from 115 sites around the country in a clinical study, randomizing them into two groups. The criteria specified women with tumors under 2cm in size; no palpable lymph nodes; and no spread of the cancer to other parts of the body.
All of the women had a sentinel node biopsy (removal of one or two lymph nodes); breast conservation surgery (lumpectomy), and whole-breast radiation. All of the women were identified as having either one or two cancerous lymph nodes.
In the past, just one positive node would have meant removal of most, if not all of the remaining lymph nodes under the arm. Doctors believed that if the cancer had spread outside the breast, there was every chance it had gone beyond a single node; best to simply remove them all.
But here’s what the study sought to prove: contrary to long-held beliefs, removing some or all of the remaining lymph nodes doesn’t improve survival, nor reduce recurrence rates.
Half the women in the trial had at least 10 additional nodes removed. The other half, none. And at a median follow-up of 6.3 years, recurrence and survival rates were virtually identical for both groups.
How could this be? Researchers conclude that radiation and/or chemo and/or long-term hormone therapy are just as effective as surgery at fighting cancer that’s spread to the lymph nodes.
So why is this news being received with sadness and frustration by breast cancer survivors all over the country?
Because it appears that for over 100 years, ever since surgeons began regularly removing underarm lymph nodes to fight cancer, women have been subjected to more surgery than they needed. Surgery which often resulted in serious complications, including shoulder issues; infections; and lymphedema, a potentially crippling arm condition that can occur immediately after surgery, or up to decades later.