Researchers at Allegheny General Hospital in Pittsburgh are arguing that doctors may want to step away from testing and treating very small amounts of breast cancer. For decades, there has been a raging debate among oncologists as to what to do when a women who has had breast cancer treatments is found to have no cancer in her sentinel lymph nodes through normal testing but is found to have very small amounts of cancer known as micro metastases upon more intensive analysis. Sentinel nodes are normally the first lymph nodes to receive cancer cells from the breast tumor and can be removed with a surgical procedure. AGH Breast Care Center Associate Director Thomas Julian says their study found that women who had aggressive treatment for cancers under 2 millimeters have a survival rate after 5 years that is just 1.2 percent better than those who are not treated. “When you look at that one to one-and-a-half percent difference, it’s kind of hard to improve on that by giving more intense chemotherapy, so why go chasing for these teeny tiny amounts if you’re not going to treat the patient,” says Julian.
The study randomly assigned 5,611 breast cancer patients with clinically negative auxiliary lymph nodes to undergo either a sentinel node biopsy alone, or a sentinel node biopsy plus auxiliary dissection. Julian says studies done in the past used to argue for more treatment were riddled with poor testing procedures. They did a poor job of detecting the cancer in the first round of testing, says Julian. He says this shows the power of doing good, scientific based research.
While the debate may never be over, Julian says this study and another like it will swing the pendulum toward non-treatment. “For most [Doctors] it will give them satisfactory information so they can treat their patient adequately and not have to pursue things,” says Julian, “There will always be somebody who says, ‘you know, I’m really worried you have this teeny tiny little bit of cancer in there and
I think you should get more treatment.’” Julian says by not testing or treating, doctors will save women the negative side effects associated with such procedures. It could also save money. He says he expects the American Society of Clinical Oncology and the National Comprehensive Cancer Network to issue new treatment guidelines in the coming years reflecting the new information.