Study Supports Forgoing Axillary Dissection in Some Patients With Breast Cancer

Friday, February 11, 2011

A study published Wednesday in JAMA found that, among a small subset of patients with breast cancer, axillary dissection in patients with sentinel node metastases does not significantly affect survival rates. The study was covered by the mainstream media with a New York Times’ reporter describing it as turning “standard medical practice on its head.” Although the findings are exciting for breast cancer patients, nurses play a key role in helping patients understand the limitations of the findings.

“Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial” involved 891 randomized patients with clinical T1-T2 invasive breast cancer (i.e., early-stage disease, small tumors in size), no palpable adenopathy, and 1-2 sentinel lymph node dissection (SLND)-containing metastases.  The women in the study were treated with breast-conserving surgery, whole-breast irradiation, and adjuvant systemic therapy.

“Nurses have a huge responsibility to explain patients’ treatment choices,” said Suzanne Mahon, RN, DNSc, AOCN®, APNG, Clinical Professor at Saint Louis University Cancer Center. She explained that more choice is a good thing for some patients, while others find it “mind-boggling.”

“Patients and their healthcare providers have to compare the risks and rewards of many different treatment decisions, and it is important for nurses to help clarify the options,” Mahon said. She emphasized that while this study is “good news for people fall into that category,” they only apply to a small subset of patients. She noted that while axillary dissection is not a “benign” procedure and increases the risk of developing lymphedema, patients who undergo sentinel node dissection are still at some risk of developing the potentially debilitating symptom.

Mahon, who described the study as “exciting,” says she hopes the findings will help reduce some of the barriers to mammography screenings. She explained that many women fear breast cancer so much that they do not obtain their routine screenings. However, as research continues to build support for less-invasive treatments, women may begin to realize that with early detection of breast cancer , newer treatments may cause far less body image disruption than treatments in the past.