Breast-cancer patients with even the tiniest spread of the disease to a lymph node have a much higher risk of it recurring years later and may need more treatment than just surgery, new research suggests.
For years, doctors and patients have struggled with what to do about a microscopic tumor or stray cancer cells in a lymph node.
Women with “micro tumors” usually are given estrogen-blocking drugs, chemotherapy or both; those with isolated cancer cells usually are not because those were thought to be of low concern.
The new study challenges that view. It suggests that either type of metastasis, or spread, raises the risk of cancer showing up in the breast or anywhere else in the body in the next five years by about 50 percent.
“This took an area that was very gray and, I think, made it black and white,” said Dr. Linda Vahdat, director of breast- cancer research at Weill Cornell Medical College and an adviser for the breast-cancer patient website of the American Society of Clinical Oncology.
“If we’re considering treating the patient, we probably should,” Dr. Daniel Hayes, director of breast-cancer treatment at the University of Michigan, agreed. “It really does look like our biases are wrong.”
Vahdat and Hayes had no role in the study, which was done by researchers throughout the Netherlands.
The results are included in today’s New England Journal of Medicine.
The study is not ideal: It just observed a large number of women rather than assigning some to get treatment and comparing how they fared with others who were not treated.
In the U.S., many women with early-stage breast cancer are given hormone blockers.
“The big issue is, should these patients also get chemotherapy?” Hayes said.
However, not all women benefit from chemotherapy, even when their risk of a recurrence is high, said Dr. Eric Winer, breast-cancer chief at the Dana-Farber Cancer Center in Boston.
“Patients are looking for more specific treatment” tailored to their individual tumor type — not necessarily more or less treatment, he said.
