Sunday, October 8, 2017

New Research Which Could Have More Thought

There is always more research going on - especially cancer research. Especially breast cancer research. I swear sometimes the world is full of research labs papered in breast cancer research papers.

Anyway, this time I don't necessarily agree with this new research. In a ten year study, maybe not all breast cancer patients need an AND (Axillary Node Dissection) if they have a positive sentinel node with their lumpectomy. Why? Because if you are going to have chemo and full breast radiation, they would catch all the cancer cooties and nuke them anyway. Hmmmm.....

An AND can give you lymphedema.... which I have now.... the real reason for skipping this surgery. And who wants additional surgery anyway?

Okay so this study looked at around 900 women who had early stage breast cancer and one or two positive sentinel nodes and then were having chemo, radiation and hormonal therapy. They split them in two groups and followed them for ten years. After that time both groups had similar recurrence rates. This study did not include women who had mastectomies or suspicious or enlarged lymph nodes in a physical exam.

"To make sure that women have the appropriate lymph node surgery, the American Society for Clinical Oncology released guidelines on sentinel lymph node biopsy for people diagnosed with early-stage breast cancer. The guidelines say sentinel lymph node biopsy SHOULD be offered under these circumstances:
  • breast cancer in which there is more than one tumor, all of which have formed separately from one another (doctors call these multicentric tumors); these types of breast cancers are rare
  • DCIS treated with mastectomy
  • women who have previously had breast cancer surgery or axillary lymph node surgery
  • women who have been treated before surgery with chemotherapy or another systemic treatment (treatment before surgery is called neoadjuvant treatment)
The guidelines say sentinel node biopsy SHOULD NOT be offered under these circumstances:
  • the cancer is 5 cm or larger or locally advanced (the cancer has spread extensively in the breast or to the nearby lymph nodes)
  • the cancer is inflammatory breast cancer
  • DCIS treated with lumpectomy
  • the woman is pregnant
The guidelines also say:
  • Women with negative sentinel node biopsies shouldn’t have axillary node surgery.
  • Women with one or two positive sentinel nodes who plan to have lumpectomy plus radiation also don’t need axillary node surgery.
  • Women who have one or more positive sentinel nodes and plan to have mastectomy with no radiation should be offered axillary node surgery."
Well, I say whoop-di-doo to all this. Why? Because they do not raise the issue of younger women with breast cancer. I was under 50 when I saw diagnosed with breast cancer - otherwise I meet the criteria. And it was my second cancer before the age of 50 (which puts me in a special class of people). 

I think that while these recommendations sound great and I like it when guidelines are updated and progress is made. But I think this research clearly overlooks the group of younger women who should be regarded differently. Often younger women are diagnosed with more aggressive breast cancers than older women. Now you see my concern?

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