Thousands of women could now be spared one of the most debilitating side-effects of breast cancer treatment—lifelong swelling of the arm—according to new research. Lymphoedema, a long-term condition causing swelling in the body's tissue, affects nearly one in five breast cancer patients following surgery to nearby glands.
Radiotherapy vs. Invasive Surgery
Previously, experts suggested that doctors could treat women whose cancer has spread to glands under the arm with radiotherapy rather than invasive surgery, thereby lowering the risk of lymphoedema. However, it was unclear whether the approach could be offered to women undergoing a mastectomy or those with larger tumours. Now, presenting their findings at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago, researchers are confident that surgery is largely unnecessary in these patients.
Survival Rates
Results even showed that survival rates were slightly higher in the group that did not have surgery to remove the glands, with 94 per cent of patients surviving their disease for at least five years.
Commenting on the findings, Dr Jane Lowe Meisel, an expert in breast cancer, said: "These findings have the potential to simplify surgical management and meaningfully impact breast cancer survivorship for women throughout the world. Lymphedema can be a devastating quality-of-life issue that alters a woman's mobility, appearance, and self-esteem long after breast cancer treatment is complete. This rigorous, large-scale trial proves that we can safely skip invasive axillary node dissection in patients with limited nodal disease, and that by avoiding this additional surgery, we can drastically reduce long-term arm complications and improve arm function for breast cancer patients even years out from their diagnosis."
Study Details
The study followed 2,540 women from Sweden, Denmark, Germany, Greece, and Italy, aged around 61 years old, whose cancer had spread to one or two nearby lymph nodes found under the arm. Around a fifth of breast cancers can spread to these nodes, usually resulting in a procedure to remove additional nodes to stop the disease from spreading. However, around half of women who have the procedure develop lymphoedema.
In this study, researchers wanted to see whether avoiding surgery would be safe for women with tumours larger than two millimetres. Patients—a third of whom had opted to have their breast removed—were randomly assigned to have the surgery, known as an axillary lymph node dissection (ALND) and radiation, or just radiation alone.
Quality of Life Assessment
To assess arm-related side effects, the women were asked to complete questionnaires one, three, and five years after treatment. These included questions about how well they could lift heavy objects or drive, as well as breast-cancer specific side effects including fatigue, brain fog, and mood changes. The patients rated their symptoms on a scale from 0 to 10 and then 0 to 100, with higher scores meaning the most severe arm problems and symptoms.
After five years, women who avoided the surgery reported significantly better arm function. While the survival rate was similar between groups, the group that did not have surgery performed slightly better overall.
Expert Conclusions
The study's lead author, Dr Jana de Boniface, concluded: "After previous trials, it was unclear whether the omission of ALND could also be offered to patients receiving a mastectomy or those with larger tumors. The key finding is that more axillary surgery in itself does not improve survival in these patients. This is extremely important because it means that axillary surgery should be seen as a diagnostic instrument, not a therapeutic tool."
Impact on Patients
Lymphoedema affects more than 200,000 people in the UK, most commonly as a result of cancer treatment. Breast cancer is the most common cancer in women in the UK, with around 59,000 new cases each year. In the US, breast cancer accounts for around 322,000 new diagnoses predicted in 2026.
Bunia Gorelick, associate director of research at Breast Cancer Now, said: "We know that when lymph nodes are removed during breast cancer surgery, lymphoedema can be a side effect that can cause discomfort, dry skin, arm stiffness, and overall negatively impact people's quality of life. We welcome any new research that can reduce side effects of treatment so that everyone diagnosed with breast cancer can live and live well. While this early research suggests that, for some people, omitting lymph node removal can improve their quality of life without compromising on their survival, we need to see larger trials with longer follow-up to truly explore the possibilities of adapting treatment guidance."
What is Lymphoedema?
Lymphoedema is a long-term condition that causes swelling in the body's tissues, usually developing in the arms or legs. It affects up to 10 million people in the US and more than 200,000 in the UK. It occurs when the lymphatic system, a network of channels and glands that remove excess fluid and help fight infections, does not work properly. As well as swelling, which is often worse during the day, other symptoms may include an aching, heavy feeling, difficulty moving, repeated skin infections, hard tight skin, wart-like growths, fluid leaking from the skin, and folds developing in the skin. Lymphoedema can be inherited or occur as a result of infections, injuries, or cancer treatment. Around one in five women with breast cancer and half with vulval cancer develop lymphoedema. There is no cure; treatment focuses on minimising fluid build-up via compression stockings and a healthy lifestyle.
