New technique reduces side effects for breast cancer patients

A new technique significantly reduces the side effects of breast cancer surgery, scientists report in the Journal of Clinical Oncology today [1].

Usually women undergoing surgery for the disease have most of the lymph glands under their arms removed, to stage the tumour and gauge the need for drug treatment. But the procedure can lead to a range of side effects, such as shoulder stiffness, nerve-related pain and swelling of the arm.

Now a team including Stephen Duffy, Cancer Research UK’s Professor of Cancer Screening, has published the most thorough results to date on an alternative technique called Sentinel Lymph Node Biopsy (SLNB). The results show that the technique leads to significantly fewer side effects.

The new technique involves removing two or three lymph glands from the armpit and testing them for cancer cells. The procedure is designed to tell surgeons whether or not removing the remaining lymph glands – known as axillary lymph node dissection (ALND) – is necessary.

Professor Duffy says: “Improvements in surgery have played a key role in bringing  breast cancer survival rates to over 80 per cent.

“But the benefits of surgery come at a price. The side effects that can result from having lymph glands removed can be very uncomfortable and long lasting.

“With this new technique, the first – or sentinel – lymph glands that drain the breast tumour are taken out and tested for signs of cancer. The procedure tells doctors whether or not removing the remaining lymph glands will be necessary, which means less surgery for the many women whose cancer has not spread to the lymph glands”.

A number of studies have already shown that Sentinel Lymph Node Biopsy is effective at picking up cancer cells in the armpit, and have indicated that it can reduce certain side effects. This is the first randomised controlled trial to yield such detailed data on the technique’s impact on side effects.

A total of 298 patients with early breast cancer from Addenbrooke’s, West Suffolk and Kings Lynn Hospitals took part in the trial, half of whom had standard surgery and half were treated with the new technique.

The researchers measured in detail both physical side effects and psychological wellbeing in both groups of women during the year after their operation. Professor Keith Miller of the University of Glasgow’s Department of Behavioural Sciences collaborated with the team on the psychological aspects of the study.

Incidence of lymphoedema – a chronic swelling of the arm – was 70 per cent lower in the SLNB group than in the ALND group.

Women who had the new technique were also 60 per cent less likely to experience paraesthesia, an abnormal feeling of numbness, tingling, prickling or burning in the arm that affects between 70 and 80 per cent of patients who have standard treatment.

Quality of life and psychological wellbeing were both significantly better in the SLNB group.

Mr Arnie Purushotham, the trial’s principal investigator at Addenbrooke’s Hospital in Cambridge, says: “Sentinel Lymph Node Biopsy is becoming more widely available in the UK. This study provides the most detailed information to date on the technique’s benefits with regard to side effects.

“We have measured psychological wellbeing and quality of life factors as well as physical side effects. It is very important to measure such factors, as cancer treatment can impact so heavily on the patient as a whole.

“We are very grateful to the patients who agreed to participate in this trial. Their contribution has been invaluable”

Professor John Toy, Cancer Research UK’s Medical Director, says: “The results of this trial are very promising. They show that Sentinel Lymph Node Biopsy can greatly reduce the number of women who experience side effects after surgery for breast cancer.

“We now need to confirm that testing the sentinel glands is an accurate way of showing that cancer has not spread to glands in the armpit, and thus can be used with complete confidence to help plan appropriate patient management.

“Although preliminary data from various studies indicate that this is the case, doctors need to ‘follow up’ women who have taken part in trials for at least five years to be completely certain.

“Once we have all of this information, surgeons will be able to consider offering Sentinel Lymph Node Biopsy as standard treatment.”

ENDS