Today in breast cancer news, we'll look at two studies of how socioeconomic factors affect MRI and radiotherapy use rates and four recent papers on axillary lymph node dissection.
Use of diagnostic MRI and adjuvant radiotherapy vary with socioeconomic factors
A May 17 study in The Journal of Surgical Research examined diagnostic MRI rates for Medicare patients from 2003 to 2005. Overall, diagnostic MRI use increased from 3.9% of eligible patients in 2003 to 10.1% in 2005. Women who were younger, Caucasian, living in metropolitan areas or living in wealthy areas were more likely to receive MRI.
A June 15 study in Cancer acknowledged the benefits of radiation therapy after breast conserving surgery and looked at factors influencing the use of radiation in Kentucky. The rate of radiotherapy use was "drastically lower" for women older than 70 and those living in rural Appalachian areas. It was "modestly lower" for African Americans, those with DCIS and the uninsured. The 10 year survival rate for those who received breast conserving therapy plus radiation was 79.7% compared to 67.6% for those who received surgery alone.
Four June research papers on axillary lymph node dissection
So far this month, there have been four research papers on the use of axillary lymph node dissection (ALND).
Characteristics of patients who were spared ALND
A June 1 study in the Canadian Journal of Surgery found that, in British Columbia, patients who had sentinel lymph node biopsy (SLNB) rather than complete axillary lymph node dissection (ALND), had more sentinel lymph nodes (SLN) removed, a lower percentage of positive SLNs and lower pathological stage than those who had complete ALND. Most of the SLNB group received radiation to the axilla. Complications, including lymphedema, were 21% in the ALND group and 7% in the SLNB group. Recurrence rates were similar for both groups.
Diminishing rates of ALND use over the last 10 years
Researchers from Memorial Sloan-Kettering Cancer Center in New York examined 10 year trends in ALND use in a June 7 study in the Annals of Surgical Oncology. Over that time, ALND rates diminished for patients with "low-volume" sentinel lymph node metastasis. According to the authors, the "trends suggest a more nuanced approach to axillary management." If current selection criteria had been applied during the entire 10-year period, 48% of ALND would have been avoided, "sparing 13% of all patients the morbidity of ALND."
Micrometastases and the risk of axillary lymph node metastasis
This month, two studies examined the association between sentinel lymph node micrometastases and axillary metastasis.
The first, a June 2 study from Korea in the Annals of Surgical Oncology concluded that "[m]icroinvasive breast cancer is associated with a low rate of lymph node metastases." Some patients with micrometastasis at "low likelihood" of lymph node metastases "may be spared lymph node evaluation."
The second study, from Spain, published in the Revista Espana de Medicina Nuclear examined axillary lymph nodes which had been dissected from early-stage patients with micrometastases in the sentinel lymph nodes. 79.1% of the dissected axillary nodes were negative, 8.3% had micrometastasis and 12.5% had macrometastasis. The authors concluded that for patients wtih micrometastasis in the lymph nodes, the "low percentage of further axillary invasion. . . may open up the possibility of avoiding" complete ALND "in favor of other adjuvant treatments (chemotherapy, radiotherapy)."
I wanted to mention two unique elements of today's news update. First, all of this news has been sorted and organized for you on the LATESTBreastCancer.com website. For example, all four axillary lymph node studies are on our ALND page. We hope that makes it easy to see the latest research all in one place. Also, all of today's news comes straight from actual research abstracts. We don't just read media headlines. Although we do follow media coverage of breast cancer news, we also read hundreds of breast cancer research abstracts a week. Both are added to our website daily and can easily be found on the treatment pages of our site.
Please check back tomorrow for more breast cancer news and research updates.