Spare node-negative cancer patients complex therapy - more than one-third of breast cancer patients with negative axillary nodes do not need adjuvant chemotherapy or hormonal therapy

Nutrition Health Review, Wntr, 1991

More than one-third of breast cancer patients with negative axillary nodes (NAN) can be spared routine adjuvant therapy, according to new research by an expert from the Breast Evaluation Center at the State University of New York at Buffalo School of Medicine.

This finding may put to rest the widespread belief that all NAN patients should receive routine systemic adjuvant chemotherapy or hormonal therapy, Professor Dr. Dutzu Rosner, Coordinator of the Breast Evaluation Center, has declared.

"NAN patients represent a heterogeneous population in terms of risk and prognosis, and should not be treated as if they were all the same," said Professor Rosner. Rosner has identified four subjects of patients who have an excellent chance of recovery using surgery alone and who should be spared routine administration of systemic adjuvant therapy.

In May 1988, the National Cancer Institute issued a clinical alert calling for the routine use of systemic adjuvant therapy for all NAN breast cancers, an endorsement that has fomented a passionate debate around the United States on the risks, benefits and cost-effectiveness of such treatment.

Rosner believes it makes more sense to identify subjects of low-risk, good prognosis NAN breast cancer patients who could be spared the agony and financial cost of unnecessary additional treatment. "During the past few years we have accelerated our efforts to isolate those NAN breast cancer patients who would most likely benefit from adjuvant systemic therapy from those who might be spared," he said.

Rosner presented data on 408 patients with invasive breast cancer with negative nodes with radical surgery alone or with conservative surgery with or without local irradiation at Roswell Park Cancer Institute in Buffalo, New York, between 1976 and 1987. "We used simple, reproducible, cost-effective, first-generation prognostic factors -- such as tumor size, tumor grading, age, type of surgery and hormone receptor status to precisely identify good-prognosis' NAN patients," he explained.

One major advantage of Rosner's research was that it was conducted in a single institution, with standard surgical therapy, histologic and tumor grade reading, special clearing of axillary nodes, steroid receptor assays, and with a current follow-up for over 95% of cases. "Many problems were avoided because our methods were standardized and we had a centralized base of operations," he said.

An average number of nodes were examined in axillary dissection. "The removal of such a large number of axillary nodes helped to eliminate false-negative findings, allowing for a more accurate analysis of therapy results," noted Rosner.

"We have clearly demonstrated that it is not only possible, but essential, to identify those 'good prognosis' NAN patients who should be spared unnecessary treatment," said Rosner. "Routine administration of systemic adjuvant therapy is, in my assessment, costly, unjustified, and, in some cases, risky."