Because of the widespread use of mammography and other screening practices, today breast cancer is now detected early for many women, often allowing for less invasive surgeries and better treatment outcomes. When early breast cancer (stage I) is diagnosed, a procedure to remove the lymph nodes under the arm is performed to determine whether or not the cancer has spread (called an

axillary lymph node dissection) and to move forward with the best treatment strategy. Now, Dutch researchers say that women who are postmenopausal and are undergoing a lumpectomy and radiation therapy for stage I breast cancer may not need an axillary lymph node dissection.

Breast cancer is characterized by the presence of cancer cells in the tissue or ducts of the breast. Depending on the stage of disease (extent of the cancer at diagnosis), treatment options may include surgery, chemotherapy, radiation therapy, and/or hormone therapy. Usually, an important part of treatment for persons with breast cancer is surgery to remove the cancer and surrounding tissue (

lumpectomy) or to remove the whole breast (

mastectomy). After surgery, radiation therapy to the breast area or chemotherapy may also be given to prevent recurrence (return) of the disease. In addition, hormone therapy with an agent called

tamoxifen has been shown to help prevent cancer recurrences in women whose disease is affected by hormones (called

hormone receptor-positive).

For women diagnosed with stage I breast cancer, a lymph node dissection is often performed at the time of surgery to determine whether the cancer has spread to the lymph nodes under the arm. This information allows the doctors to present their patients with the most effective treatment options. However, radiation therapy to the breast and under arm area has been shown to significantly reduce the risk for recurrence of cancer in the breast, even when the cancer has spread to the lymph nodes under the arm. For this reason, researchers are now questioning whether an axillary lymph node dissection is really necessary. The answer to that question is an important one, as many women would prefer to forego the procedure because of its potential side effects.

Researchers in the Netherlands evaluated the outcomes for 105 postmenopausal women, averaging 64 years of age, who had stage I breast cancer. All underwent a lumpectomy followed by radiation therapy to the breast area. Seventy-five women also received hormone therapy with tamoxifen. None had axillary lymph node dissection. The results showed that 13% of the women had a recurrence of breast cancer: 1% occurred in the breast only, 8% occurred in distant parts of the body only, 2% occurred in both the breast and distant parts of the body, and 2% occurred in both the area near the breast and distant parts of the body. These findings show that radiation therapy was highly effective in reducing the number of recurrences in the breast. Furthermore, the side effects of the radiation therapy appeared to be fewer than those expected with both the lymph node dissection and radiation therapy. More recurrences of cancer were observed in women whose disease was not sensitive to hormones (

hormone receptor-negative).

The researchers concluded that a lumpectomy followed by radiation therapy to the breast and under arm area is an effective and safe treatment for stage I breast cancer. They further suggested that such radiation therapy may be considered a valuable alternative to axillary node dissection for postmenopausal women with hormone receptor-positive stage I breast cancer. With regard to women with hormone-negative stage I disease, axillary node dissection is not likely to decrease the incidence of cancer recurrence; therefore, these women too may prefer to forego the axillary node dissection and receive surgery and radiation therapy. However, all women should be considered for treatment with tamoxifen.

Given these findings, postmenopausal women with stage I breast cancer may wish to talk with their doctor about the risks and benefits of undergoing surgery and radiation therapy with or without axillary lymph node dissection, or of participating in a clinical trial in which promising new treatment approaches are being studied.

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