For patients with the earliest stage of breast cancer, lymph node biopsies do not benefit them or improve outcomes, a study out of Yale shows.
DCIS (ductal carcinoma in situ) is breast cancer that has formed in the milk ducts. It is the earliest stage of breast cancer and is typically noninvasive. Roughly 60,000 women are diagnosed with DCIS every year in the United States.
This is the first study to show evidence that lymph nodes biopsies are not beneficial to patients with DCIS. These finding should hopefully lead to improved treatment guidelines.
“Our study actually showed that there is no benefit of sentinel node biopsy in terms of breast cancer mortality, breast cancer recurrence or invasive breast cancer,” said Shi-Yi Wang, co-author of the study. She’s a health services researcher at Yale School of Public Health in New Haven, Connecticut.
The study was published in the Journal of the National Cancer Institute Cancer Spectrum and lead by researchers at Yale.
Using the Surveillance, Epidemiology, and End Results-Medicare database, which contains about 12,000 patients, the team identified 1,992 women who received a sentinel lymph node biopsy. They then identified 3,965 women in the database who did not have the biopsy and who had similarities to the patients who had, such as age and tumor characteristics.
All the women in the study were 67 years old or older, had been diagnosed with DCIS sometime between 2001 through 2013, and had received breast-conserving surgery.
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Looking at the two groups, the researchers found three key results. First, there was no significant difference between the groups when it came to recurrence and needing a mastectomy. There was also no significant difference between groups when it came to invasive breast cancer cropping up in the same breast later on. Third, both groups had a similar rate of death from breast cancer.
Lymph node biopsies experienced a strong uptick in the first part of the century. All lymph node biopsies for patients with DCIS who received breast-conserving surgery rose from around 20% to 44% between 1998 and 2011. This happened in large part because the rate of sentinel lymph node biopsies — which are the ones closest to the original site of the cancer — increased sharply, from around 7% to 39%.
“Unnecessary surgery places patients at higher risk for surgical complications and adds to overall healthcare costs,” said Bridig Killelea, co-author of the study and a Yale associate surgery professor.
Thankfully, most surgeons have already stopped performing this procedure on patients with DCIS. However, some still do. Hopefully these findings will lead to improved and updated guidelines for all breast cancer surgeons to follow.Whizzco