Breast cancer treatment in Minn. already following new study guidelines

In this photo taken on Thursday, May. 6, 2010, radiologist Dr. Gerald Iba checks mammograms at The Elizabeth Center for Cancer Detection in Los Angeles.
AP Photo/Damian Dovarganes

Breast cancer care in the Twin Cities is rapidly moving toward less aggressive surgery for the disease when it has migrated to a woman's lymph nodes.

Doctors at several metro-area cancer centers say they have already dialed back their surgical policies after learning about a stunning new study. The data showed there is no difference in survival between women who had more of their lymph nodes removed and those who did not.

Breast cancer patients say they're thrilled to have a less invasive treatment option, that's equally effective.

The study, published in the influential Journal of the American Medical Association, captured news headlines across the nation last week.

But as early as last September, breast cancer surgeon Todd Tuttle remembers reading some preliminary results from the study in another, smaller journal, the Annals of Surgery. That article prompted a lively discussion among Tuttle's colleagues at the University of Minnesota's Masonic Cancer Center.

"This is a practice-changing study. Breast centers all across the country are deciding what to do with the results of this study," said Tuttle. "We've had the same discussions here. And it has dramatically changed our practice."

Tuttle says almost immediately after reading the study last fall, he and his colleagues agreed they would no longer remove additional lymph nodes in early-stage breast cancer patients who had microscopic disease in their lymph nodes.

"Breast centers all across the country are deciding what to do with the results of this study. ... It has dramatically changed our practice."

Doctors at the Piper Breast Center in Minneapolis made the same decision in December, after bringing one of the study's authors to their center to answer questions about the data. Margit Bretzke is a surgeon at Piper.

"Whenever we present a lumpectomy option to a patient now, and their nodes ... appear to be negative, we talk about this study," said Bretzke.

Restraining their surgical approach wasn't as easy as it sounds. Bretzke says there's a long tradition among breast cancer surgeons of removing lymph nodes with any sign of cancer. But she says the results of the study are just too compelling to ignore.

There was no difference in recurrence of disease or survival between the women who had the lymph node procedure and those who did not.

For many patients, the change in treatment means they will have a much lower risk of developing lymphedema -- a painful condition that causes swelling and numbness in the arm.

"That was really comforting to know that I might not have to have more invasive surgery," said Lucille, one of Dr. Bretzke's patients. "I was very aware of the possible outcome, and I know people who have had lymph nodes removed and who suffer from lymphedema."

MPR news agreed not to use Lucille's full name because she hasn't told all of her family members about her cancer diagnosis.

Lucille, 53, says she feels fortunate that she received her diagnosis in time to take advantage of the study. Without it, she probably would have had her lymph nodes removed unnecessarily.

"It's fantastic," she said. "It's wonderful that there's so much research going on. And that the research continues to provide treatments that are less invasive."

But patients should not assume that all breast cancer surgeons will be familiar with the new data.

Margit Bretzke at the Piper Breast Center says patients may need to advocate for themselves.

"I would tell women that when they're talking to their surgeon, to bring it up to see if they're in fact a candidate for avoiding a node dissection," said Bretzke. "They need to challenge their surgeon and ask the question. I would say if their surgeon doesn't seem to know what they're talking about, they ought to get a second opinion."

Women who are most likely to qualify for a less invasive breast cancer surgery must have small breast tumors with no obvious sign of significant cancer in their lymph nodes on imaging scans or during a physical exam.

Candidates must be willing to undergo a lumpectomy, followed by whole breast radiation and possibly chemotherapy or hormone therapy to destroy any remaining cancer cells.

Women who receive mastectomies without radiation or chemotherapy where not part of the study, and therefore, not considered good candidates for this treatment option.