21 Feb 2011
Removing cancerous nodes still recommended, despite the findings on survival rate
DOCTORS here have urged patients not to panic after an American study found that removing cancerous lymph nodes from some breast-cancer sufferers did not improve survival rates.
The study has led some clinics in the United States to change the way they carry out treatment. But hospitals and cancer centres here are not following suit, saying that more extensive studies are needed.
There is no need for patients scheduled to have all their lymph nodes removed to panic, said Parkway Cancer Centre’s medical director, Dr Ang Peng Tiam.
Breast cancer is the most common cancer among women here. There were 7,160 new cases and 1,649 deaths between 2004 and 2008, said the latest Singapore Cancer Registry report.
The US study, published in the Journal of the American Medical Association this month, involved 891 women with early-stage tumours. They were given sentinel lymph node biopsies, which detect cancer in lymph nodes. They were then randomly chosen to have 10 or more nodes removed or no action taken.
Both groups had similar five-year survival rates – 92.5 per cent for those who had nodes removed, and 91.8 per cent for those who did not.
For now, doctors here say removing cancerous nodes is still recommended. It helps prevent the cancer recurring, said Dr Hong Ga Sze, who heads the breast department at KK Women’s and Children’s Hospital.
Patients with one to three cancerous nodes have a 50 per cent risk of the disease recurring. For those with more than six, the risk escalates to more than 90 per cent, said Dr Ang.
The impact of the US study on patients here is likely to be further limited because fewer now undergo lymph node removal surgery, thanks to new procedures.
In the past, every patient used to have all her lymph nodes removed. But women now undergo biopsies instead. One or two nodes are removed from the underarm to check for cancer cells.
Patients will have surgery to remove all their lymph nodes only if cancer is detected.
At the Singapore General Hospital, where the biopsy became standard practice in 2005, about a third of patients had all their lymph nodes removed last year.
Less than half of KKH’s patients – about 40 per cent – underwent the surgery. These are patients who sought help at a later stage when the cancer had spread to the lymph nodes.
“We are trying to do less and less invasive surgery these days,” said Dr Benita Tan, a consultant at Singapore General Hospital who has published studies on local cancer trends.
Patients will instead be advised to go for chemotherapy or radiotherapy where suitable.
The doctors said their caution about the US study is also due to factors such as the fact that too few patients were studied.
Tracking patients for only six years is not enough to reach a concrete conclusion on how well they manage to survive the cancer. It can take 10 to 15 years to resurface, Dr Hong said.
The study involved patients who had only up to two affected lymph nodes and who had radiotherapy and chemotherapy, which might have killed the cancer cells in the armpit.
This may explain why the patients in the study did as well even without the lymph node surgery, said Dr Tan.
In the past, every patient used to have all her lymph nodes removed. But women now undergo biopsies instead. One or two nodes are removed from the underarm to check for cancer cells. Patients will have surgery to remove all their lymph nodes only if cancer is detected.
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Dept of O&G
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