Lymph node study may change treatment of breast cancer

Many breast cancer patients won't need procedure

CLEARWATER, Fla. - Marion Mage is a concert pianist whose music overflows into many areas of her life. So when she learned she had breast cancer and may have to have lymph nodes under her arm removed, she said, "My biggest concern was that it would affect my arm."

Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would keep the cancer from spreading, and thereby prolong a woman's life.

But removing all lymph nodes often results in debilitating side effects.

Doctor Peter Blumecranz is a breast surgeon at Morton Plant Hospital’s Breast Care Center. “The biggest and worst of that is lymphedema. That's swelling of the arm. It can get big and swollen and can stay that way the rest of your life. Unfortunately, there is no way to fix it if you have it."

Marion would, “Pray every day, ‘Please God, just don't let that happen to me.’ Because at that point, playing was my livelihood."

But Dr. Blumencranz, Marion’s surgeon, was involved in a study to see if removing all of a woman's lymph nodes had any advantage.  The study, eventually published in the Journal of the American Medical Association, included Marion and around 1,000 others over five years.

The women in the study had surgery followed by radiation and chemotherapy. Some had lymph nodes removed, others did not. Dr. Blumencranz says, “It turns out reoccurrence under arms and overall survival from their breast cancer were identical whether you had other nodes removed or not. This is practice-changing. That's why it so important. This flies in the face of all prior teachings and changes the way we manage breast cancer."

Dr. Blumencranz took out five of Marion's lymph nodes because cancer had spread to the first two but he left the rest. But she says, “I've had a cousin who had almost the same exact surgery two years later, not in this state. Cancer showed up in two or three of her lymph nodes and they just took all of them and she's having all kinds of problems with the swelling of her arm, the lymph fluid.  In hindsight, we are very glad we were part of this study."

Because after one month of recovery, Marion has had no side effects at all.

If you’d like to read the study click on this link: http://jama.ama-assn.org/content/305/6/569.abstract?sid=5c13d302-0de3-4493-a6cd-62eb3915de4b

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