The practice of removing armpit lymph nodes in patients with early breast cancer may not be necessary or particularly beneficial, a new study in The New England Journal of Medicine suggests.
Early-stage breast cancer has traditionally been treated with removal of the primary tumor and nearby lymph nodes. Pathologists then examine the nodes that were closest to the tumor for evidence that cancer cells have started to spread to other parts of the body.
So-called axillary nodal status has long been regarded as one of the most important prognostic factors in breast cancer and is used to guide therapy.
But lymph node removal often comes with pain, swelling, numbness, and risks of infection and fluid buildup. As medical therapies for breast cancer have improved, the need for lymph node removal is being questioned.
To learn more, researchers recruited 5,502 patients with breast tumors no greater than 5 centimeters and normal-appearing lymph nodes and randomly assigned half of them to skip armpit lymph node removal.
At five years, 91.7% of the retained-lymph node group and 91.9% of the removed-lymph node group were still free of invasive disease, and 98.2% and 96.9%, respectively, were still alive.
Patients whose lymph nodes were removed were less likely to eventually have a recurrence found in a lymph node, but that didn't afford them any benefit in terms of survival without invasive disease, or overall survival.
An editorial published with the study notes that the findings are in line with those of a similar trial reported in 2023.
While noting that more study is needed, Dr. Eric Rubin, Editor-in-Chief of the journal, said in a statement, "We are beginning to see a future where many women with early-stage breast cancer are going to be able to avoid axillary-node dissection and its attendant complications."
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