thought provoking article aimed at breast surgeons

[Lani]

ABSTRACT: Are we wasting our time with the sentinel technique? Fifteen reasons to stop axilla dissection [The Breast]
Originally, surgery for breast cancer involved removing the pectoral muscles and the regional lymph nodes. This drastic technique was based on Halsted's paradigm of continuous tumour spread via the lymph nodes. In the last century, the amount of surgery has gradually decreased as breast cancer has been recognised as a primary systemic, or partially systemic, disease. Nowadays, breast-conserving therapy is widely used, but axillary lymph node dissection (ALND) and the sentinel technique are still common. Can the patient also be spared such axillary surgery? We have assembled convincing arguments against ALND (and therefore also against the sentinel technique) based on the probability that positive lymph nodes are unlikely to metastasise and that removing them is redundant. At least a discussion of this topic is more than overdue, even if it may be too early to change behaviour.

Don't go out and declare that sentinel node biopsying is unnecessary just yet!

It is just nice to see surgeons questioning age-old "unquestioned medical knowledge" and reevaluating why they do what they do.

[al from Canada]

Lani,

I think you know my thoughts on surgery and the activation of growth-factors such as the EGFR family, (this includes HER2), so I agree with the article.... only to a point. Time will tell I guess.
Al

[Mgarr]

Lani,

I have a tough time with all the medical articles so I may be off base here but this was my experience.

I had partial mast. & sentinel node procedure. The node was dissected in the OR & said to be clear (after path there was a 4mm met) so 10 days later I was having an axillary node dissection because of the "national standard for care" anyway, my surgeon indicated that roughly 97% of the time with micro met the patient will be clear and he was beginning a collection of data to indicate whether the standard for full node dissection should be changed.

I also had 2 fine needle biopsies & 1 core biopsy before surgery. Being fearful & anxious at the time, if I did it all again I would not have had the core biopsy. -Thinking on what Al believes - I questioned my surgeon about activation of the disease (not realizing the growth factor) and he indicated that yes, he does believe that can & does happen. So I guess the question is what about core biopsies? My lump at initial diagnosis was 2cm my lumpectomy turned into partial mast by the time it was taken out it was 3.5cm.

Mary

[CLTann]

I kept saying that biopsies, particularly core biopsy, can cause the cancer to spread. One pinhead needle can spread AIDS, why can't such a giant core instrument? Just like the advice given by doctors that mosquitoes do not spread AIDS. I asked a doctor after his speech: would he be willing expose himself in a room with known AIDS patients with plenty of mosquito around? He said, of course, he will not stay in that room.


Ann

[romo9]

Dear Lani I am a bit confused as we are always led to believe the more lymph nodes positve the worse the prognosis? can anyone shed some light on this? thanks RO

[Sammy]

Same thing happened with me. My tumor was 1.5 cm before biopsy. It was confirmed by 3 ultrasounds. When fine needle biopsy confirmed cancer , I feel core biopsy is not required at all. Once the diagnosis is confirmed and medical management is not going to change then what's the point of doing biopsy. I questioned many doctors after I realized how stupid I was to go through all these procedures and not use my common sense. During lumpectomy my tumor was 2.5 cms ( actually it was no longer a node, it had broken. I could feel my node before biopsy but after that it just became flat. My report also said that it was flattened out) . The issue is that when you speak to these medical doctors they say "It's standard procedure" , wonder if any of these so called "doctors" have slight common sense . I wish they used logic instead of following books like dummies. Medical science is no longer a hidden science . All that these doctors read is available on the interent and perhaps patients going through a specific disease know more than what doctors know. The only factor that differentiates doctors and educated patients is their experience. if they can't use their experience and make proper judgement then one has to study so hard before taking any doctor's recommendations.

Sorry, just venting my anger out. I strongly feel medical procedures need to be refined. Medical doctors need to apply common sense. I wonder if they just consider this profession as money making tool. I have come across very few compassionate doctors, most of them don't care. My surgical oncologist even said this "when you go to your radiologist remember ( the guy that I was going to see) is very blunt and may not have consideration for any of your feelings and fear". I was surprised when she said that. How can one not care for a person who's going through such a big challenge ? I don't even have words express my disappointment.

[Bev]

My tumor went from 1.5 to 2.9 after core biopsy. I could see and feel that it had. Maybe it swelled from the trauma. When I asked the surgeon she said perhaps the path was measuring microscopic pieces not seen in the MRI, etc as tumors just don't grow that fast. Hmm... Don't know the answer about pos nodes, RO, hope to see a post. BB