A Game-Changer In The Fight Against Breast Cancer?

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MELISSA BLOCK, host:

Now, to the new study that's prompting a radical rethinking of breast cancer surgery. Researchers found that many women with early stage breast cancer do not need to have a large number of lymph nodes removed. The study found that survival rates for women who had a lumpectomy followed by chemotherapy and radiation were the same whether the lymph nodes were removed or not. The findings will spare tens of thousands of women unnecessary surgery.

Dr. Elisa Port is chief of breast surgery at Mount Sinai Medical Center in New York. She says removing lymph nodes can lead to painful complications.

Dr. ELISA PORT (Chief of Breast Surgery, Mount Sinai Medical Center): Removing all of the lymph nodes under the arm is, first of all, for many women a second trip to the operating room. And secondly, there's a lot of side effects associated with removing all of the lymph nodes under the arm.

There's a higher risk of developing what we call lymphedema, which is swelling of the arm. There is some numbness on the inner part of the arm that you can get from cutting through the little nerves that run near the lymph nodes, and some women even have mobility issues. So sparing them this bigger surgery is certainly significant for a large number of women.

BLOCK: And when you heard about the findings of this study saying that further lymph node surgery was unnecessary, what were you thinking?

Dr. PORT: Basically, you know, this has been sort of an evolution. We have known for a long time now that chemotherapy and radiation are effective, and they've gotten better and better. You know, the parallel to this is that in the 1980s women started having lumpectomy instead of mastectomy. We knew we were leaving microscopic amounts of cancer behind in the breast, but those were taken cared of by radiation in the vast majority of cases.

So this is really sort of a parallel to that where we take out a couple of lymph nodes. And if there's just a small amount of cancer in those lymph nodes, then the understanding is in the rest of the lymph nodes, there's either no cancer, or if there is, there's just a small amount left and that should easily be mopped up by these other treatments.

BLOCK: It sounds, though, Dr. Port, like there are a number of doctors who don't believe these findings, frankly, who thought that even carrying out this study was dangerous to women. One of the study's authors has said about this, look, the dogma is strong. In other words, if there's cancer in the lymph nodes, all the lymph nodes need to come out.

Dr. PORT: Right. But there is no question that for many people the results that you don't have to remove cancer are very counterintuitive and go against the sensibility of what we, as surgeons, have been ingrained to do, which is remove cancer. And the more cancer you can remove, the better.

Doctors are supposed to do what they know to be the safest thing, and many of us erred on the side of caution, which is to take out those lymph nodes to make sure we weren't missing anything.

BLOCK: Dr. Port, are you getting a lot of calls from your patients today?

Dr. PORT: I am. You know, I'm getting calls from patients who are having surgery later this week talking about how this would affect their management.

BLOCK: When you think about the trend toward less surgery - first the shift from mastectomy to lumpectomy and now this new study - do you think it's possible to imagine a day when there would be no breast cancer surgery that would be necessary?

Dr. PORT: Yes. I would love to take early retirement because we've found treatments that are effective. I certainly think it's possible one day. I think, thankfully, until that time, you know, we are working on improving the options that we have, and so patients have to go through less and suffer less to give them the best shot at cure.

BLOCK: Dr. Elisa Port is chief of breast surgery at Mount Sinai Medical Center in New York.

Dr. Port, thanks very much.

Dr. PORT: Thank you for having me.

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