Recent studies suggest that some early-stage breast cancer patients may be able to forgo certain surgical procedures, potentially lightening their treatment load. One study, featured in the New England Journal of Medicine, investigates the necessity of lymph node removal in early-stage breast cancer cases. A second study published in the Journal of the American Medical Association offers insights on an approach for ductal carcinoma in situ (DCIS), a particular type of breast cancer.
Both studies were presented at the San Antonio Breast Cancer Symposium. In the United States alone, approximately 50,000 women receive a DCIS diagnosis each year. In this condition, cancer cells develop in the lining of the milk ducts while the surrounding breast tissue remains unaffected. Although many women opt for surgical intervention, it remains debatable whether a “watch and wait” strategy involving more frequent monitoring could suffice.
The research, spanning two years, indicates that active monitoring could serve as a viable alternative for a significant number of women with low-risk DCIS. However, some medical professionals express caution, suggesting that longer follow-up is essential to validate these results. “This option for patients to consider is indeed intriguing,” noted Dr. Virginia Kaklamani from the University of Texas Health Science Center San Antonio, who was not part of the research. “For an extended period, it has been suspected that many DCIS cases may be treated excessively. This research seems to confirm our assumptions.”
Conversely, Dr. Monica Morrow from Memorial Sloan Kettering Cancer Center emphasized that a two-year study may not provide adequate conclusions on treatment efficacy for this condition. The analysis followed over 950 patients in the U.S. who were randomly assigned to either surgical intervention or active monitoring. All participants had low-risk DCIS and no identifiable invasive cancer presence. Most participants received hormone-blocking medications as part of their treatment.
Results after two years revealed similar low rates of invasive cancer between both groups, with roughly 6% of the surgical group and 4% of the monitoring group being diagnosed with invasive cancer. For those in the monitoring group, a change in mammogram results would lead to a biopsy, and they retained the option to undergo surgery at any point if deemed necessary.
Additionally, some participants deviated from their assigned treatment groups, leading to a further analysis of those who truly underwent surgery versus those who remained in the monitoring group. This analysis indicated that the invasive cancer rate stood at about 9% for the surgical population compared to approximately 3% for the monitoring group. The researchers intend to continue tracking these patients over a decade to see if these findings hold.
Tina Clark, 63, from Buxton, Maine, joined the study after her DCIS diagnosis in 2019. Assigned to the monitoring-only group, she successfully avoided surgery and radiation, a significant relief as she coped with the complexities of raising a teenage nephew while grieving her husband’s passing. “I am incredibly grateful to have found this study,” Clark shared.
Currently, she has biannual mammograms to monitor her DCIS, which has remained stable. However, a recent mammogram revealed a different small cancer in her other breast, leading to a lumpectomy for its removal. Dr. Shelley Hwang, a study author from Duke University School of Medicine, remarked, “If diagnosed with low-risk DCIS, patients have the chance to learn more about their condition and gauge their treatment options.”
Furthermore, the practice of sentinel lymph node biopsy—removing select lymph nodes in the armpit to check for potential cancer spread—is often performed alongside breast cancer surgery. Nonetheless, this procedure can result in long-lasting side effects such as pain and swelling in the arm. Consequently, new research aims to clarify when this additional surgery might be unnecessary. Previous studies have indicated that older women with smaller tumors could safely avoid lymph node removal.
The latest German research focused on whether women with early-stage breast cancer, anticipating breast-conserving surgery, could skip lymph node removal altogether. In this study, 4,858 women were randomly allocated to either have their lymph nodes removed or not. Five years later, about 92% of participants in both groups remained alive and cancer-free. Dr. Morrow noted, “Not only does lymph node removal not enhance survival rates, but the likelihood of cancer recurrence in the armpit is quite low when lymph nodes are preserved.” Despite this, it is important to acknowledge that some patients may still require lymph node analysis to determine appropriate post-surgery treatment regimens.
