Breast cancer patients can safely skip invasive surgery that leaves 1 in 5 with lifelong arm swelling, major trial shows

Thousands of women can now avoid lifelong swelling of the arm, one of the most debilitating side effects of breast cancer treatment, research has found.

Lymphedema is a long-term condition that causes swelling in body tissue; and almost a fifth of breast cancer patients experience this condition following surgery to nearby glands.

Experts have previously suggested that doctors could treat women whose cancer has spread to the glands in the armpit with radiotherapy rather than invasive surgery, thus reducing the risk of lymphedema.

But it was unclear whether the approach would be offered to women who had mastectomies or women with larger tumors.

Now the researchers, who presented their findings at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago, are confident that surgery is largely unnecessary in these patients.

The results showed that survival rates were slightly higher in the group that did not have surgery to remove the glands, with 94 percent of patients surviving their disease for at least five years.

Commenting on the findings, breast cancer specialist Dr. Jane Lowe Meisel said:

‘These findings have the potential to simplify surgical management and meaningfully impact breast cancer survival for women worldwide.

‘Lymphoedema can be a devastating quality of life problem, changing a woman’s mobility, appearance and self-confidence long after breast cancer treatment has been completed.

‘This rigorous, large-scale trial proves that we can safely skip invasive axillary lymph node dissection in patients with limited nodal disease and, by avoiding this additional surgery, greatly reduce long-term arm complications and improve breast cancer patients’ arm function even years after diagnosis.’

The study followed 2,540 women aged approximately 61 from Sweden, Denmark, Germany, Greece and Italy whose cancer had spread to one or two nearby lymph nodes in the armpit.

About one-fifth of breast cancers can spread to these nodes; this often results in a procedure that removes additional nodes to stop the spread of the disease.

However, approximately half of the women who have this procedure develop lymphedema.

In this study, researchers wanted to see whether it would be safe to avoid surgery for women with tumors larger than two millimeters.

Patients, a third of whom chose to have their breasts removed, were randomly assigned to receive the surgery, known as axillary lymph node dissection (ALND) and radiation, or radiation alone.

To assess arm-related side effects, women were asked to complete questionnaires at one, three and five years after treatment.

These included questions about how well they could lift heavy objects or drive, as well as side effects specific to breast cancer, such as fatigue, confusion and mood changes.

Lymphedema is a long-term condition that causes swelling in body tissue.

Patients rated their symptoms on a scale of 0–10 and then 0–100; higher scores meant the most severe arm problems and symptoms.

After five years, women who avoided surgery reported significantly better arm function.

Although the survival rate was similar between groups, the non-surgery group did slightly better overall.

The lead author of the study, Dr. Jana de Boniface concluded: ‘After previous trials, it was unclear whether omission of ALND could be recommended for patients undergoing mastectomies or for those with larger tumours.

‘The main finding is that more armpit surgery does not improve survival in these patients.

‘This is extremely important because it means that armpit surgery should be viewed as a diagnostic tool, not a therapeutic tool.’

Lymphedema affects more than 200,000 people in the UK; often a result of cancer treatment.

Breast cancer is the most common cancer in women in the UK, with around 59,000 new cases each year.

Breast cancer accounts for nearly all cancer diagnoses in the United States, and it is estimated that 322,000 women will be diagnosed with this disease in 2026.

Bunia Gorelick, deputy director of research at Breast Cancer Now, said: ‘We know that when lymph nodes are removed during breast cancer surgery, lymphoedema can be a side effect that can cause discomfort, dry skin and arm stiffness, and generally have a negative impact on people’s quality of life.

‘We welcome any new research that can reduce the side effects of treatment so that everyone diagnosed with breast cancer can live and live well.

‘This early research suggests that for some people, skipping lymph node removal may improve their quality of life without compromising their survival. ‘We need larger studies with longer follow-up periods to truly explore the possibilities of adapting treatment guidance.’

WHAT IS LYMPHOEDEMA?

Lymphedema is a long-term condition that causes swelling in body tissues.

Lymphedema is a long-term condition that causes swelling in body tissues.

It usually develops in the arms or legs.

Lymphedema affects up to 10 million people in the USA and more than 200,000 people in the UK.

It occurs when the lymphatic system does not work properly.

The lymphatic system is a network of channels and glands that remove excess fluid and help fight infections.

Besides swelling, which often gets worse throughout the day, other symptoms may include:

• A painful, heavy feeling
• difficulty moving
• repeated skin infections
• Tough, tight skin
• wart-like growths
• fluid leaking from the skin
• Folds developing in the skin

Lymphedema may be hereditary or occur as a result of infections, injuries, or cancer treatment.

Approximately one in five women with breast cancer and half of women with vulvar cancer develop lymphedema.

There is no cure.

Treatment focuses on minimizing fluid accumulation through compression stockings and a healthy lifestyle.

Source: NHS Choices