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 Researchers followed 140 women aged 70 or older who generally had
smaller, slow-growing tumors. Even though none of the women got a
so-called sentinel node biopsy to see where the tumors might have
spread, over the next five years only four of them died of breast
cancer.
“For women this age with early breast cancer, a biopsy may not
affect the treatment or the outcome,” said senior study author Dr.
Armando Giuliano, head of surgical oncology at Samuel Oschin
Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los
Angeles.
Worldwide, breast cancer is the most common malignancy in women.
About one in nine women will eventually develop it, according to the
U.S. National Institutes of Health. The risk increases with age,
from 1 in 227 at age 30 to 1 in 26 by age 70.
Over the last decade, sentinel node biopsy has become the most
common tool for determining if cancer has spread beyond the initial
tumor into the lymph nodes. The procedure involves injecting a dye
near the tumor to locate the nodes closest to it, and then removing
them to test for cancer. If these nodes are cancer-free, it’s likely
that the rest of the lymphatic system will be, too.
Last year, the American Society of Clinical Oncology (ASCO)
recommended more women get sentinel node biopsies instead of an
older, more invasive procedure known as an axillary lymph node
dissection that requires surgeons to remove five to 30 nodes to test
for cancer. Giuliano co-chaired the ASCO panel responsible for the
new guidelines.
In the current study published in JAMA Surgery, Giuliano and
colleagues reviewed data on women who had breast-conserving surgery
without a sentinel node biopsy at Cedars-Sinai. None of the women
had any obvious lymph node abnormalities show up during exams in the
doctor’s office.
Half of the women were at least 83 years old. All of them had tumors
that were less than 5 centimeters (2 inches) across, and most had
malignancies that were no more than 2 centimeters (3/4 inch).
In addition, 86 percent of the women had what’s known as
estrogen-receptor positive breast cancer, a type of slow growing
tumor that responds to hormone treatment.
After five years, 70 percent of the women were still alive. Most of
the women who died weren’t killed by breast cancer. Instead, the
most common cause of death was heart disease.
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Because the study only included women who didn’t get a sentinel node
biopsy, the results can’t prove that survival odds are just as good
as they would be with this diagnostic test.
But the researchers note that 85 percent of women 70 and older with
node-negative malignancies die of causes unrelated to breast cancer.
“Older women tend to have (slow-growing) breast cancers and more
medical problems than younger women and very often they don’t die of
breast cancer,” Giuliano said. “Frequently, they don’t get
chemotherapy because they wouldn’t tolerate it, and they are going
to get hormone treatment no matter what you find in the biopsy.”
Sentinel node biopsy only needs to be done if it will make a
difference in treatment, said Dr. Monica Morrow, chief of the breast
service in the surgery department at Memorial Sloan Kettering Cancer
Center in New York.
It is standard practice for younger women who are less likely to
have small tumors that respond to hormone treatment, said Morrow,
who wasn’t involved in the current study. For these women, the test
can show whether they would benefit from having all lymph nodes
removed or getting chemotherapy or radiation.
For patients who would only get chemotherapy based on cancer in the
lymph nodes, the test makes sense, she said in an email. Otherwise,
it doesn’t improve survival.
“Twenty years ago, tumor in the nodes was the big determinant of
treatment,” Morrow said. “That is no longer true today.”
SOURCE: http://bit.ly/1d42Mia JAMA Surgery, online May 27, 2015.
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