Micrometastases in Sentinel Node Don’t Worsen Breast Cancer Survival

Detection of very small areas of cancer (micrometastases) in the sentinel lymph node through use of highly sensitive testing is not associated with breast cancer outcomes. These results were published in the Journal of the American Medical Association.??

For women with early breast cancer, determining whether the cancer has spread to the axillary (under the arm) lymph nodes is an important part of cancer staging. Many women initially undergo a sentinel lymph node biopsy, in which only a small number of nodes (or even a single node) is removed. If the sentinel nodes show evidence of cancer, many women then undergo additional lymph node removal.???

For some women, evaluation of the lymph nodes will reveal very small areas of cancer known as micrometastases. Whether these very small areas of cancer affect breast cancer outcomes has been uncertain.?

To explore the relationship between sentinel node micrometastases and breast cancer outcomes, researchers evaluated information from more than 5,100 women with early-stage breast cancer. Women were treated with breast-conserving surgery, sentinel lymph node biopsy, whole-breast radiation therapy, and (when appropriate) chemotherapy and/or hormonal therapy.?

Women whose sentinel nodes were cancer-free by conventional testing underwent additional, more sensitive testing in order to identify very small areas of cancer that were not detected by initial testing. Researchers also collected bone marrow samples in order to detect small areas of cancer in the bone.??

Of the sentinel nodes that tested negative (cancer-free) by conventional testing, 10.5% tested positive for micrometastases by more sensitive testing. The presence of micrometastases, however, did not affect overall survival or the risk of cancer recurrence. ?Three percent of the bone marrow samples tested positive for cancer. Although these patients appeared to have a shorter survival, the presence of cells in the bone marrow was not an independent predictor of survival.? In other words, the finding of tumor cells in the bone marrow did not provide additional information to assist in clinical decision-making.?Current approaches to breast cancer treatment may have contributed to the effective management of sentinel node micrometastases. A majority of the study participants received systemic therapy (chemotherapy +/- hormonal therapy).?

These results suggest that micrometastases in the sentinel nodes do not significantly affect the outcome of early-stage breast cancer. Highly sensitive testing to detect lymph node micrometastases does not appear to be warranted.???

At this time, based on the available data, women with early stage breast cancer should not have routine bone marrow aspirates to look for tumor cells.?

Reference: Giuliano AE, Hawes D, Ballman KV et al. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. Journal of the American Medical Association. 2011;306:385-393.?

Posted August 1, 2011

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Pregnancy Doesn’t Appear to Worsen Breast Cancer Outcomes

According to the results of a study conducted at the M. D. Anderson Cancer Center, women who are diagnosed with breast cancer and treated with chemotherapy while pregnant have a better disease-free survival (survival without a cancer recurrence or a new cancer) than women who are not pregnant at the time of diagnosis. Overall survival was similar in the two groups of patients. These results were presented at the 2010 Breast Cancer Symposium.

Previous reports have suggested that being pregnant at the time of diagnosis worsens breast cancer outcomes. This may have been due to older approaches to cancer treatment, in which pregnant women received less effective cancer treatment than non-pregnant women or delayed cancer treatment until after the birth of the baby.

A recent study compared breast cancer outcomes between pregnant and non-pregnant women who were treated with 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC).[1] In pregnant women, treatment with FAC was administered after the first trimester of pregnancy. When additional therapies—such as hormonal therapy—were warranted, these were started after the woman gave birth. Each of the 54 pregnant breast cancer patients treated was matched with two non-pregnant patients based on age and stage of cancer.

Overall survival between pregnant and non-pregnant women was similar. In fact, pregnant women appeared to have a slightly better overall five-year survival (77%) than their non-pregnant counterparts (72%). ??????????? This difference, however, was not statistically significant and may be the result of chance alone.

For five-year disease-free survival, results were significantly better for pregnant women: 74% versus 56% for non-pregnant women.

These results suggest that with current approaches to treatment, pregnancy does not worsen breast cancer outcomes. In a prepared statement, one of the authors of the study stated “Now, when we are counseling breast cancer patients who are pregnant, we can say that they should have every expectation that they will do as well as our non-pregnant patients, and that they should start their treatment in the second or third trimester without delay.”[2]

References:

[1] Litton JK, Warneke CL, Hahn K, et al. Case-control analysis of patients (pts) treated with chemotherapy during pregnancy for breast cancer (BC). Presented at the Breast Cancer Symposium, Washington, DC, October 1-3, 2010. Abstract 105.

[2] MD Anderson News Release. UT MD Anderson Study Finds Women Treated for Breast Cancer While Pregnant Have Improved Survival. 09/29/10.

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