[Editor’s Note: This post was originally published on Diana’s personal blog on February 9, 2011. Breastcancer.org covered the study results she mentions here: Sentinel Node Dissection Poses No Breast Cancer Survival Hazard.]
In case you’re a day or two behind with ‘big news,’ yesterday really big news regarding standard breast cancer treatment was released indicating that there is no decrease in life expectancy in women diagnosed with breast cancer that has spread to the axillary lymph system who have only a sentinel lymph node removed versus those who have had a full lymph node dissection.
This is important information for all women to know, and thank goodness these researchers went ahead with their study to evaluate “conventional wisdom,” even though some cancer centers refused to participate, saying it was unethical. (I suggest reading the full article from the New York Times and/or JAMA for further information about the women included in this study and discuss with your own doctor how these results may or may not be applicable in any specific breast cancer case.)
I am glad science (and resulting medical care) keeps marching on and changing based on more thinking and understanding (someone asking “why not?” instead of just “why?”), in this case, changing to be less damaging to women undergoing this drastic surgery of removal of large numbers of (potentially healthy) lymph nodes, leaving them with increased risk of developing multiple physical problems. Even though I have been very fortunate to not have had to suffer with the development of lymphedema since either surgery (1984 and 1995), I know that it could still develop, and I am one of these women for whom neither right or left shoulder, arm, or hand function or sensation has ever returned to normal.
I have been left with limitation of the use of both of my arms (and I had to beg for physical therapy in 1995 to even get back as much range of motion and function as I have in that arm and shoulder). In addition, I had significant pain in my arm after my 1995 surgery for which my surgeon offered no post-op explanation, advice, let alone any sympathy. Eventually 3+ years after my surgery, I casually mentioned this pain to a massage therapist (I had gone for another reason) who worked specifically with shiatsu therapy on that pain. Even though I was pleasantly skeptical that anything would help, and almost did not go back to the second appointment because the first session initially increased the pain level in that arm, I burst into tears during the second session when I could actually feel the pain traveling down my arm, leaving my body through my fingers, never to return. I still have all the same movement and sensation limitations I had developed post-surgery, but at least I continue to be pain-free, which has been a huge quality of life improvement.
Oh my, that experience sealed the deal with me to be forthright in saying our ‘conventional medicine’ as practiced here in the US knows just the tip of the iceberg about how the body works, how the body heals, and how to prevent or treat illness with minimal ‘collateral’ damage and in a manner that takes into account a person’s humanity.
I share all this not for sympathy but to share a real-life example of why this finding is important, why the research itself was important, and to say thank you to the researchers who initially questioned the conventional standard of care and pursued the study (in spite of challenges) in order to provide data that will now allow more humane treatment for many women diagnosed with breast cancer without sacrificing long-term life-expectancy.
I have just received a copy of all the research projects being funded by The American Institute of Cancer Research (AICR) for 2011, from among which I will choose the one where money from The Diana Dyer Nutrition for Cancer Survivors’ Research Endowment at AICR (funded by proceeds from the sale of my book A Dietitian’s Cancer Story
No, no, I’m not a cynical person, in spite of how that last sentence may have sounded! I’m always looking forward with hope and action. Hopefully (hope), you or someone you know will be able to put this information to use (action), too. My endowment was founded for those two reasons.
Kaara says:
Thank you so much for posting this informative article on Sentinel Node Dissection. I am in the process of being screened for possible breast cancer, and I want to be prepared with as much information as I can when I visit my primary doctor to review a plan. It was recommended that I have a breast MRI because the results of my mammogram and ultrasound were inconclusive. I’m praying it’s just hormonal changes in my breast tissue, but education is never a bad thing, and I feel better with knowledge.
GAnne49 says:
I just passed my 18 month checkup and all still lookin’ good!
I can’t help feeling somewhat vindicated in my decision – I proclaimed right from the start “minimal treatment”. I would not have ALND no matter what they found. Based on that, I also decided not to have the sentinel nodes done either. I questioned the benefit to removing sentinel nodes. It was hard getting a detailed answer, but the only justification seemed to be information with respect to staging. I have issues with removing parts just to see if they are affected – they can’t be put back if they are good, essentially exploratory surgery. Since there was no indication of any spread, good clean margins and no lymphovascular invasion on the lumpectomy, no palpable nodes, and “minimal treatment”, staging information seemed irrelevant in my decision. And at this point I always stress, my decision; it might not be the right decision for someone else.
Lymph nodes are part of the immune system. My understanding is that they serve to trap foreign material, including cancer cells, interfering with their passage to other parts of the body. There is a great deal of immune activity in the nodes. Why would you remove them when they appear healthy? Those were and still are my questions about that whole process. In my early research prior to surgery I ran across some articles questioning the necessity of ALND even if small numbers of cancer cells were found. I suspect this study is the result of those “questions”.
In keeping with “minimal treatment”, I also passed on the chemo. I did take six months of hormone treatment (Arimidex) but that’s all I could take. I admit, I have a very low tolerance for side effects and perhaps a higher risk tolerance otherwise. I’m taking vitamins – C, E, and lots of D, trying to lose some weight and eating (and drinking) better. Oh, and an Aspirin a day – the full 325, always with my heaviest meal of the day.
Over time it seems that initial treatment has become less and less aggressive as people have questioned the necessity of certain treatments. At one time, not that long ago, breast cancer almost always meant full mastectomy and lymph node removal.