These findings are highly significant, as sentinel node surgery is far less painful and does not have the same risk of serious side effects as the more extensive procedure. Radical lymph node surgery can lead to the onset of serious infection, as well as a condition called lymphedema. The latter is a painful, chronic swelling in the area of the arm and armpit that can range from mild to so severe that the mobility of the arm becomes seriously restricted.
Tempering the Excitement
The findings of the JAMA study are good news for many breast cancer sufferers. However, it needs to be emphasized that the results of this study are only applicable to about 20% of all breast cancers. In order for sentinel node surgery to be a viable alternative to the more radical operation, tumors in the breast can be no larger than a quarter, must have clean margins, and cannot have spread to other parts of the body, most especially the lymph node system as a whole.
It is also interesting to note that some doctors who have a history of performing radical lymph node surgery are expressing skepticism about the results of the new study, claiming the sample size is not large enough and the evidence is not conclusive. This judgment certainly seems counterintuitive and without merit. It is impossible not to wonder if this reaction may stem in part from defensiveness on the part of doctors who feel their past actions are being now being scrutinized with a critical eye.
Surgery-Happy Oncologists?
It was only ten years ago that the sentinel node biopsy came into use as a way to detect the possibility that breast cancer may have begun to spread into the lymph node system. Before that, removal of lymph nodes from beneath the arm was a way for oncologists to discover just how far breast cancer had actually spread. Given the technical limitations that existed until just a relatively short time ago, it is probably unfair to suggest that surgeons were performing clearly unnecessary surgeries on a regular basis for many decades.
However, once suspicions began to arise about the necessity for this surgery in some cases, medical professionals involved in the fight against breast cancer had a responsibility to sit up and take notice – and thankfully, some did. Those doctors who had already begun to partially phase radical lymph node surgery out of their surgical repertoire certainly deserve credit for doing the right thing, even before there was a definitive study that backed up what their sharply-honed insights and instincts were telling them.
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