To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ASBD: Emphasis on Lymph Node Involvement May Fade in Breast Cancer Prognostication and Therapy Selection URL: http://www.pslgroup.com/dg/2305BA.htm Doctor's Guide April 14, 2003
By Steve Carrell DALLAS, TX -- April 14, 2003 -- Emphasis on lymph node metastases to predict breast cancer survival will fade, as will the frequency of axillary node dissection, said Blake Cady, MD, a surgery professor at Brown University Medical School, Providence, Rhode Island. Dr. Cady discussed the future of breast cancer prognostication and therapy selection during his keynote address here on April 11th at the American Society of Breast Disease Annual Symposium. There are several reasons for the decreasing emphasis. For instance, Dr. Cady explained, the number of nodal metastases should decrease because the growing acceptance of mammography screening means finding smaller cancers with fewer nodal metastases. Also, modern analysis has changed the information gained from sentinel node study. With 6 to 15 slides of a sentinel node, tiny collections of potentially troublesome cells appear. But the new, sixth edition of the American Joint Committee on Cancer Staging System for Breast Cancer says not to use sentinel node biopsy results for therapeutic decisions. Dr. Cady said, "We simply don't know what they mean." Breast cancer metastases occur when circulating cancer cells and the endothelial lining of distant organs match. Lymph node metastases are indicators, not governors, of distant metastases and survival, Dr. Cady said. His article in next month's issue of Archives of Surgery will further explore indicators of poor prognosis, he said. Decreasing emphasis on lymph node metastases naturally means fewer axillary node dissections. In fact, there are only 3 indicators for such dissections, he said: 1. for clinically positive axilla if confirmed by ultrasound and fine-needle aspiration cytology; 2. after neoadjuvant therapy of node metastases with or without response; and 3. for recurrence in regional nodes. Instead of emphasizing lymph node involvement, physicians will increasingly study primary tumor features for prognostication and systemic therapy selection. Eventually, sophisticated genetic analysis of the primary cancer will eliminate even conventional primary prognostic features such as size and grade, he said. [Study title: Clinical Breast Cancer: An Ideal Model of Basic Surgical Oncology Principles.] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.