More treatment needed?

Even tiny breast cancer spread raises risk of recurring

The Associated PressAugust 13, 2009 

  • For decades, many doctors warned breast cancer survivors that lifting weights or even heavy groceries could cause painful arm swelling. New research shows that weight training actually helps prevent this problem.

    "How many generations of women have been told to avoid lifting heavy objects?" Dr. Eric Winer, breast cancer chief at the Dana-Farber Cancer Center in Boston, asked after seeing the results of the new study. "Women who were doing the lifting actually had fewer arm problems because they had better muscle tone."

    The study was led by Kathryn Schmitz, an exercise scientist at the University of Pennsylvania, and funded by the federal government. Results are in today's New England Journal of Medicine.

    Women who have had radiation to the armpit, or lymph nodes removed to check for cancer, can suffer lymphedema -- a buildup of fluids that causes painful and unsightly swelling of the arms or hands.

    To avoid it, doctors have advised women to avoid using the affected arm to lift toddlers, carry a heavy purse or scrub floors. Even activities like golf and tennis raised concern.

    Schmitz challenged that notion with a small study several years ago, finding that weight training did not make lymphedema worse. Her new study is the first one large and long enough to give clear proof that this is so, and even suggests that weightlifting can help.

Breast cancer patients with even the tiniest spread of the disease to a lymph node have a much higher risk of a recurrence 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 a woman's risk of having cancer show up in the breast or anywhere else 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 Web site of ASCO, the American Society of Clinical Oncology.

"I think it will influence treatment," she said of the study. "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," he said. "For the first time, it suggests that isolated tumor cells or micrometastases do have biological significance."

Vahdat and Hayes had no role in the study, which was done by researchers throughout the Netherlands. Results are 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 to others who were not treated. The study also was done at a time when treatment was less aggressive and in a country where doctors had been treating breast cancer more conservatively than in the United States.

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.

The Dutch study involved more than 2,700 women with low-risk, early stage cancer -- small tumors that did not seem aggressive. All had surgery to remove their breast tumors. All of their armpit lymph nodes or a few key ones called "sentinel" nodes were removed and checked for signs of cancer. Doctors do this by examining tissue slices from the nodes and using special stains to make cancer cells show up.

In most cases, breast cancer doesn't return after surgery. Among women in the study who were given no additional treatment, 86 percent of those with no cancer in lymph nodes were free of cancer five years later. Only 76 percent of those with micro tumors and 77 percent of those with isolated cancer cells were cancer-free.

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