Breast Cancer Treatments

When it comes to women’s health, things seem to change every minute. The simple fact of the matter is that medicine changes every minute; new technological advancements are made, innovative studies produce shocking results, and clinical procedures are proven unnecessary. A few months ago, women’s medicine was given a new protocol for mammograms, and just last week a study published in the Journal of the American Medical Association stated that “less is more” when it comes to breast cancer treatment.

In the American Medical Association study, researchers found the most conventional way of treating breast cancer, removing lymph nodes from the armpits of patients, was unnecessary for many patients. When breast cancer is diagnosed early, radiation and anti-cancer drugs are just as effective as surgery to remove the lymph nodes, the study indicated.

Conventional Breast Cancer Treatment

Conventional treatment methods for breast cancer, up until this point, include complete removal of lymph nodes from the armpits to eliminate all possibility of the cancer traveling through those nodes to the rest of the body. Physicians examine the nodes after removal to determine the extent of cancer integration in the body.

Up until this point, removing the lymph nodes was considered  the safest way to decrease a women’s risk for cancer spreading to the rest of her body. The lymph nodes are a key factor in the way our immune system functions, and should one area become infected with cancer, it will quickly spread throughout the body.

Removing all of these lymph nodes has its consequences, mainly lymphedema, a painful and chronic condition where the arm and hand swells and becomes immobile.  Nearly 33 million women who have undergone breast cancer surgery and lymph node removal are affected by lymphedema.

History of “Conventional” Breast Cancer Treatments

According to USAToday, for most of the 20th century, the standard treatment for breast cancer was radical mastectomy – the removal of one or both breasts, underlying muscle and the lymph nodes.

From that procedure, which was incredibly traumatic for patients, breast cancer treatment evolved to the point where mastectomies were no longer needed. In 1985, a study confirmed that a lumpectomy was just as effective as removing the entire breast. This, combined with radiation, became the standard for patients, but removal of the lymph nodes has remained the same procedure for nearly 100 years.

Q: Surgeons have been removing lymph nodes from the armpits of breast cancer patients for 100 years. Why has it taken so long to find out that not every patient needs this surgery?

A: The procedure is a holdover from the era of the radical mastectomy, before radiation treatment and chemotherapy existed and when the only hope for controlling cancer was to try to cut it all out. Removing lymph nodes became part of the standard of care, because the nodes might harbor cancer cells that could spread around the body.

Before the sentinel node technique was developed, there was no way to find which nodes were most likely to be the ones where cancer cells would land; to be on the safe side, the only thing surgeons could do was to removeas many nodes as possible. Women suffered from side effects, like lymphedema, that could be severe, but the prospect of a cancer recurrence was worse, so doctors and patients alike were afraid of what would happen if the nodes were not removed. Only when it became apparent that the sentinel node biopsy was reliable did it become possible to ask the next question: If just one or two nodes are positive for cancer, do they all have to come out?

The answer seems to be no.

Part of what makes it possible to leave the nodes alone is that there are now more effective combinations of chemotherapy and radiation, which can wipe out microscopic traces of disease that might be left behind. – New York Times

The Pace of Medical Acceptance

Even though mastectomies were shown to be unnecessary back in the 1980’s, nearly 30% of cancer physicians still performed mastectomies in 2008. In the 1990’s, Armando Giuliano of the John Wayne Cancer Institute found that removing and testing just a few lymph nodes, rather than all of them in the armpit, could determine whether the cancer had spread. It was not until the early 21st century that this procedure became conventional for cancer physicians.

What the Study Says

The key finding from this study is that for women in the early stages and with apparently limited disease before lumpectomy (what’s called a positive sentinel node) taking out all the cancerous nodes from the axilla (armpit) has no survival advantage after five years, according to the Huffington Post.

About SignatureMD:

SignatureMD (signaturemd.com), with offices in Los Angeles, California and Richmond, Virginia, is one of the nation’s largest providers of initial conversion and ongoing support services to concierge medicine physicians, with an expanding network of over 160 affiliated primary care physicians and specialists across 31 states.