Microscopic signs of breast cancer in the lymph nodes of women with early-stage disease don’t signal an increased risk of dying, according to a study that suggests testing for the tiny traces may be a needless expense.
The survival rate for women with no sign of cancer in the lymph nodes was 95 percent over five years, using a standard test, the researchers said. It remains the same even when more sensitive tests found minute signs of potential malignancy, according to a report in tomorrow’s Journal of the American Medical Association.
Doctors have long thought the existence of these so-called micro-metastases might raise the risk of death, the researchers said. Overturning that idea will likely change medical practice, said lead researcher Armando Giuliano, co-director of the breast center at Cedars-Sinai Medical Center in Los Angeles.
“If the lymph node is negative, the standard practice in this country is to do more intense stains,” or tests, to look more closely for disease, Giuliano said in a telephone interview. “It’s not helpful and there is greater expense.”
Researchers tracked the medical history of 3,904 women who had no easily identifiable cancer in their lymph nodes after being diagnosed with early stage breast cancer. All the women had a lumpectomy, surgery in which a tumor and some surrounding tissue is removed, and many received chemotherapy and radiation. The women and their doctors weren’t told the results of the more sensitive tests, so their treatment regimens didn’t differ.
“What I really want is for people not to be overtreated,” Giuliano said. “If you see these things and think they are bad, you tend to do more aggressive treatment. It will take effort to get people to change, but I think they will.”
The study, funded by the National Institutes of Health, was originally presented at the American Society of Clinical Oncology meeting in Chicago in June.
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