Thursday, August 25, 2011

Jilted ??

I feel like a jilted school girl, waiting by the phone to hear from the jerk that couldn't even remember my name the next morning...hoping that he will call asking for that second date (not that I would ever know what that was like).

The surgical onc and radiation onc - who work in tandem, were both adamant about the urgency of me getting the breast MRI. Which was done a day and half after I saw radiation onc, and scheduled by her office while I was there. Radiation onc was "not comfortable" with me waiting to have the recommended surgery after I got back from moving my 19 year old into her sophomore dorms. I would be flying back from New Hampshire on September 12. When I left surgical one's office she said that soon as she got the MRI results we would needed to do a sit down and schedule surgery - she said she would call.

"Nurse Ratched" at radiation onc's office told Mary (see last post) that radiation onc was going to call me imminently.

Urgency, urgency, urgency. Hurry up and wait.

It has now been 8 days since I saw surgical onc. Seven days since I saw radiation onc. Six days since I had the MRI. Four days since the report arrived on their respective fax machines.

I have not had a ring from anyone. Jilted!       

But, like every self-respecting school-girl, I am like soooo over them! [Insert: rolling of eyes, and a toss of the hair with hip jutted out for emphasis.]      

As with all, smart, jilted lovers (and yes, that was a self-serving pat on the back!) I have moved on to alternative pastures. Dr. John, ND (who is much cuter than either of the aforementioned ladies, btw) gave me my first Ozone Therapy treatment last evening. Besides a bruised vein and sore bicep, not too bad. Saturday I have the first of four sessions in the Life Vessel (Google it. Its right up there with the pods from Invasion of the Body Snatchers!), and I am topping off my Saturday with an IV nightcap of high dose vitamin C. Check out older posts from 2010 - four installments on therapeutic benefits of vitamin C. (Not that it seemed to be 100% effective during ILC-Round #1.)

Tuesday, August 23, 2011

John C. Lincoln Breast Health & Research Center...Revisited

Sigh...they call, but they don't leave voice mail messages. Not even a cursory message identifying themselves and asking for a call back. Why is that?

Hi. This is TC...I missed a call from you?

That wasn't me, I will forward you to our scheduler.

No, I don't need to schedule. I am trying to find out whether my Breast MRI results are completed.

That would be Mary. One moment.

This is Mary...Yes, they are ready. I am faxing them over to Radiation Onc right now.

Can you fax them to me as well.  
The 5 ft Pink Ribbon
announcing that you
have arrived at BH&RC
 No. HIPAA does not allow me. Call Radiation Onc and she can tell you the results. 

Right. Can you tell me the results.

No. HIPAA does not allow me to do that. I am not a nurse or doctor. Call Radiation Onc.

You see Mary, Radiation Onc and her personal "Nurse Ratched" are not good doing "phone."

If you were here, I could hand you the report.

I will come, and call Radiation Onc.

I leave a voice mail message for Radiation Onc as well as"Nurse Ratched."

I arrive at BH&RC. I wait for Mary. While I am waiting, I snap a few pics of the main reception area with my cell phone - being careful not to violate any one's privacy. The pic of the glowing pink pony wall doesn't give it illuminating justice.
One of 3 Glowing Pink
Pony Walls in the
 Reception Area

Mary comes out and meets with me. Apologizes for the restraint that she is under. Mary asks me if I have spoken with Radiation Onc, because she confirmed with "Nurse Ratched" that they received the report; and she let them know I was asking for my results. "Nurse Ratched" reportedly assured Mary that they would call me first thing.

No. They didn't.

Mary gives me the report - YEAH...Good news, kinda: "...[no] suspicious areas of enhancement on the right side. Oval mass [in left axillary tail] is consistent with a pathological lymph node and is positive for malignancy." Okay, nothing new, thank you Mary. But...Mary, the report states: "No prior exams were available for comparison. What happened to the three CDs I left with the nurse for the sole purpose of comparison?"

Cell Phone does not quite capture the
sparkly nature of the Reception chandelier
You left us films?               

Yes. Three CDs: first Breast MRI; PetScan; and Breast Ultrasounds.

View to the left of the door
leading into the MRI exam

Excuse me. Let me locate those. . Yes, we have located those and the report will have to be amended after Doctor reviews. My apologies for the inconvenience.

Mary is nice. Never shoot the messenger.

BTW - its is 6:30 p.m. PST. Radiation Onc's office has not called.

Pinktoberfest Already...Its Only August...Yuk!

Now this is a a guitar I would like see shredded on stage!

Hard Rock Pinktober Guitar 2011 -- Pinktober is going the way of the bermuda triangle of holdiays (Thanksgiving, Christmas & New Year)...starting earlier and earlier so retailers can get a jump start on their profit margin. Yipee skipee!

Sunday, August 21, 2011

Getting a Handle on the Abbreviations & Acronyms

My Own Little "AA" Pocket Reference

ALND = axillary lymph node dissection
ANS = Autonomic Nervous System (ANS)
BILAT = bilateral
BHRT = bioidentical hormonal replacement therapy
BRCA = breast cancer type 1 susceptibility protein
CAM = complimentary alternative medicine
CNS = central nervous system
CT = computerized tomography
DCA = dichloroacetate
DCIS = ductal carcinoma in-situ
DFS = disease-free survival
EGFR = epidermal growth factor receptor
ER = estrogen receptor
IDC = infiltrating (invasive) ductal carcinoma
ILC = infiltrating (invasive) lobular carcinoma
LCIS = lobular carcinoma in-situ
METS - metastatic
MRI =  magnetic resonance imaging
OS = overall survival
PetScan [PET] = positron emission tomography
PgR = progesterone receptor
SNLB = sentinel node biopsy

I will be adding to this list as I learn more during this next stage. This is just the basic primer for now.

Saturday, August 20, 2011

"Barbie" (TM) Does Breast Cancer...REALLY! (or...I have found the Pink Beast's Lair)



After meeting with surgical onc on Tuesday (8/16) and then the radiation onc on Wednesday (8/17), I was sent to the new "cutting edge" breast imaging center at John C. Lincoln Breast Health & Research Center. Before any slice 'n dicing can be agreed upon, the ladies (no, not the ones affixed to my upper frame, the oncs) wanted a breast MRI on both my ladies (yes, the ones affixed to my upper frame ... with crazy glue it sometimes seems). I agreed with this. Prudent, reasonable, no major radiation exposure. Let's do it. Well, that was where sanity ended and surreal began...

I have stumbled into the lair of the Pink Beast...and its name is Barbie!

Remember all the coveted Barbie (TM) play scenes. Barbie Condo; Barbie Salon; Barbie Beach Party; Barbie Corvette; Barbie does Botox...all of Barbie's unlimited fantasy lands? If Mattel were ever to decide that since Barbie is now part of the 50+ generation she should have some "real life" experiences; and, let's give her breast cancer (think Samantha a la Sex &the City); well ... they would not be able to create a better back drop than John C. Lincoln's Breast Health & Research Center.  

Grab your barf bags!

Glowing pink pony walls grab my attention as I enter the Imaging Center. There are three intake counters divided by milk chocolate floor to ceiling panels ... and bright glowing pink pony walls. Glowing because they are opaque and lit from within the walls. Accent it.

Next my attention is drawn to the textured creamy accent wall behind the intake clerks. It looks like they took a 15' x 20' rectangle of whipped cream cheese, and with flicks and swirls created hibiscus flower shapes, then sealed it in motion with silicone. Gracefully scripted is ... YES ... pink lettering with the Center's moniker.

Retro-pink patient chairs act as sentinels in front of the intake clerks. At least the upholstered backs match the milk chocolate wall panels. The actual waiting area has retro-60's, milk-chocolate bucket leather chairs. Yippee.

The wall-to-wall carpet is dotted with small pink, white and milk-chocolate geometric squares. I am dizzy.

Cream (oh...let's just call it white chocolate) textured wall paper has muted gold sparkle squiggles running vertically floor to ceiling.

I look up. Barbie (TM) et al did not disappoint...a large, faux crystal, retro-60s chandelier hangs in the center of this Barbie (TM)  menagerie. Mood lighting, I suppose.

As I sit with the intake clerk, I cough and politely turn my head to the left. As I do, my attention is caught by salon (?). An ante-chamber lined with hip to ceiling shelves of head wig stands. Sadly some are bald, but even their necks (?) are adorned with the signature pink & milk-chocolate colored scarves. Really ???

Mind you, this is just the waiting room. The secured MRI room holds it own. The linoleum floor immediately draws my eye with its large neapolitan-colored s/curve (though the pink is more bubble gum than strawberry in this room).  The wannabe Barbie (TM) interior designers went retro-modern in this area and opted for geometric plasticine lighting fixtures.

The changing room has a tiny airplane-sized sink with a ruffled milk-chocolate curtain hiding the plumbing. Privacy is provided by a heavy, embossed velvet curtain that hangs just beneath the 20' ceiling. Two lockers are available for clothing - clear but pink neon "A" and "B" identifies the different locked cubies. And, yes, there is a mini chandelier illuminating this 5' by 5' dressing cubicle. The soap is cotton-candy pink. I put on the provided quilted white robe, monogrammed with the proverbial pink ribbon that serves as a flagpole for the initials, "BH&RC".

I am taken to the injection site. Detail-oriented, and consistent, their decorator was. A large milk-chocolate - the same color as the s/curve on the linoleum, LazyBoy recliner awaits behind the pink and chocolate circles-on-cream curtain. Wow, I am now so prepped for my IV and the upcoming procedure..

I lay naked, save for the thong (now the barf bag is needed!) (BTW, the thong was blue) upon the baby-pink cushions that soften (barely) the divided well, designed to separate and suspend the ladies (yes, the affixed ones) for their close-up. I place my punim on the coordinating pink gauze that covers the face holder. Pink-tiles accent the otherwise cream-colored room. I start taking long cleansing breathes to bring both my pink-induced nausea and claustrophobia under control. Tech Michelle puts on the Stones for me (you rock Michelle!) and covers me with the robe and a baby-pink blanket. I get cold really easy. Ear plugs are put on (they are orange...ugh! fashion aux pas!) - not for the Stones, but for the deafening sounds the MRI is going to envelope me in for the next 40 minutes. Extra time is allotted because I have fake ladies. (Point of clarification...I am referring to the affixed ladies here.)


One last breath. Arms are positioned over head (think a slovenly clad pink Superman). Eyes are closed...Mick, Keith, Ronnie, Charlie stay with me! Okay, slide me in... I am ready for my pink ribbon close up. Oh, and yes the outside of the Research Center was marked with a 5 foot pink ribbon sculpture. I know, because I am 5'1".

Post Script:

Oh, if only Michelle, my tech, had been bestowed with equal attention to detail. I explain the difference to her between ILC and DCIS. I explain the difference between expanders and permanent implants. I explain why she cannot take my blood pressure on my mastectomy side. Why do I need to explain? She shares that she has been doing MRIs for 10 years, but breast MRIs only one. She asks me health hx questions so she knows how to proceed. (Kudos for questions, really! Glad it is not her interpreting the films, however.)  And she is trying to expand her understanding. Learning should be a life-long pursuit. Even if it is done in the lair of the Pink Beast!

P.S.S.: I guess Barbie (TM) truly is the poster-girl for plastic boobies. And we wonder WHY there is no cure????  

P.S.S. - It just gets better...I swung by the John C. Lincoln Breast Health & Research Center today, to pick up the amended MRI report as well as the CD -- [ALWAYS GET A COPY OF THE ACTUAL IMAGES, NOT JUST THE WRITTEN REPORT, WHETHER IT BE CD OR FILM. WHEN YOU GO TO THAT NECESSARY SECOND OPINION (or even first opinion with the intial doc) MAKE SURE THE DOC LOOKS AT WHAT THE RADIOLOGIST LOOKED AT - MISTAKES CAN BE AND ARE MADE WHEN ONLY ONE SET OF EYES IS DOING THE INTREPRETATION.  But I digress..]

They handed me the envelope with the CD of the MRI, with a written amended report. The envelope was off-white with bubble gum pink border and writing...and...wait for it...a 4-view diagram of women's breasts, right and left, drawn in the same bubble bum [sic] pink color. The envelope size was 11x17. It did catch the eye of more than one in the crowded elevator as I made my way back to the parking garage.

Monday, August 15, 2011

Advancing the Vocab


S-phase Fraction

Definition: (S faze FRAK-shun) A measure of the percentage of cells in a tumor that are in the phase of the cell cycle during which DNA is synthesized. The S-phase fraction may be used with the proliferative index to give a more complete understanding of how fast a tumor is growing. See mitosis.

Proliferative Index [Synonyms: proliferation index]

Definition: A measure of the number of cells in a tumor that are dividing (proliferating). May be used with the S-phase fraction to give a more complete understanding of how fast a tumor is growing.


Definition: (my-TOE-sis) The process of division (mitotic activity) of somatic cells in which each daughter cell receives the same amount of DNA as the parent cell.


Definition: The appearance of an individual, which results from the interaction of the person's genetic makeup and his or her environment. By contrast, the genotype is merely the genetic constitution (genome) of an individual. For example, if a child's genotype includes the gene for osteogenesis imperfecta (brittle bone disease), minimal trauma can cause fractures. The gene is the genotype, and the brittle bones themselves are the phenotype. (Medicine.Net)


Definition: noun - (Science: genetics, cell biology)
A cell or an organism consisting of two sets of chromosomes: usually, one set from the mother and another set from the father. In a diploid state the haploid number is doubled, thus, this condition is also known as 2n. adjective - Of or pertaining to a diploid, that is a cell or an organism with two sets of chromosomes.

Supplement - An example of a cell in a diploid state is a somatic cell. In humans, the somatic cells typically contain 46 chromosomes in contrast to human haploid gametes (egg and sperm cells) that have only 23 chromosomes.  (


noun. pl. an·gi·o·gen·e·ses
The formation of new blood vessels.
  • The development of blood vessels is an essential step in tumor growth.
  • A tumor cannot grow larger than a fraction of an inch without a blood supply.
  • Tumor cells produce or cause other cells to produce growth factors that stimulate blood vessel formation.

Angiogenesis Inhibitors:

noun ~ A drug that blocks angiogenesis in cancerous tissue, thus interfering with tumor growth or metastasis.
  • Some cells produce naturally occurring inhibitors of angiogenesis.
  • These inhibitors are a focus of research as possible cancer treatments.
  • Several anti-angiogenesis cancer drugs are already on the market and more are being tested.
  • Angiogenesis inhibitors have two main benefits as a treatment:

    1. They should be less toxic than conventional chemotherapy.
    2. Because they target normal cells and not the cancer cells themselves, they should be less likely to lead to the selection of drug-resistant tumors.

  • Metastasis is the process by which cancer cells spread to distant locations in the body.
  • The majority of death associated with cancer is due to the metastasis of the original tumor cells.
  • Metastasizing cancer cells must secrete a mixture of digestive enzymes in order to degrade barriers.
  • Cancer cells may use the circulatory system to move to a suitable location to settle.
  • Metastasis is a very inefficient process. Most cancer cells die once they leave the original tumor.

Lymphatic Metastasis
  • Cancer can use the lymphatic system as well as the circulatory system to metastasize.
  • The movement of cancer cells via the lymphatic system into lymph nodes is used in the detection of metastatic disease and tumor staging.

Saturday, August 13, 2011

Pondering the Myths & Mathematics of Breast Cancer


About 155,00 women are living with metastatic breast cancer in the United States and this is projected to rise to 162,000 by 2011 according to Dr. William Gradishar, Director of Breast Oncology at the Feinberg School of Medicine at Northwestern University. source: Reach MD interview 2010

In developed countries, nearly 30 % of women with early stage breast cancer will eventually develop metastatic breast cancer. (O’Shaughnessy J. Extending Survival With Chemotherapy in Metastatic Breast Cancer The Oncologist.2005; 10 (suppl 3): 20-9)

In 2008, almost 49,000 Americans, including 1,990 men, were diagnosed with metastatic breast cancer. (American Cancer Society - 2008 Statistics)

98 percent of patients with breast cancer that has not spread beyond the breast live five years or more, while only 27 percent of patients whose cancer has spread to other organs survive five years.
(Komen website Jan 2010)

Median survival after diagnosis is three years. There has been no statistically significant improvement in the past twenty years. (American Society of Clinical Oncology [ASCO] Report - 2008)

Despite the decrease in cancer mortality rates since 1990, the actual number of Americans losing their battle with the disease has hovered around 40,000 each year since at least the year 2000.
(American Cancer Society statistics 2000 - 2008)

This translates to one death from metastatic breast cancer every 14 minutes.

The Myths...
Below are, reportedly, a few of the myths that still persist about metastatic breast cancer:

Myth: Research funding is well balanced for all stages of cancer

Reality: 90% of cancer deaths result from stage IV cancer, but only 2% of research funds are devoted to stage IV.

Myth: Metastatic breast cancer is rare

Reality: 30% of breast cancer patients progress to stage IV. Many more initially present with metastatic breast cancer.

Myth: Healthy lifestyles, timely screening and early detection prevent metastasis

Reality: Metastasis happens despite vigilance and precautions. Even stage I patients can and do metastasize.

Myth: Metastatic breast cancer is becoming a chronic disease. Fewer die every year

Reality: New treatments extend life for some, but survival remains elusive. Over 40,000 women and men have been dying annually since 1987.

Myth: Stage IV breast cancer patients are well supported by many groups

Reality: Far too many patients must face their challenges with little to no support. Most programs focus on wellness and recovery, avoiding any reference to stage IV.

And now for the good news...

Statistics can be frightening… and some statistics may not even be applicable to an individual and their specific type of cancer, or their particular response to treatment.

Many statistics represent an average number. Not everyone falls into that average.

Each of us is a statistic of ONE.

Check out:

Friday, August 12, 2011

Enriching the Vocab


Axillary lymph nodes glands in the armpit that fight harmful invaders such as bacteria. The presence of breast cancer cells in these lymph nodes generally indicates that cancer is more likely to spread elsewhere in the body.

Axillary lymph node dissection Surgical removal of lymph nodes in the armpit area

Invasive cancer Cancers that are capable of going beyond their site of origin and invading neighboring tissue

Lymph nodes Glands found throughout the body that fight harmful invaders such as bacteria. The presence of cancer cells in lymph nodes adjacent to a primary tumor generally indicates that cancer is more likely to spread elsewhere in the body.

Lymphedema Swelling of arm that can follow axillary node removal as part of breast cancer surgery. It can be temporary or permanent and occur immediately or any time after.

Metastasis Spread of cancer to an organ beyond the location in which it originated

Radiation therapy Treatment with high-energy rays (X-rays) to kill cancer cells

Rock and a Hard Place...

I find this song running through my head constantly this week,
as I consider this next stage's options...

(M. Jagger/K. Richards)

The fields of Eden
Are full of trash
And if we beg and we borrow and steal
We'll never get it back
People are hungry
They crowd around
And the city gets bigger as the country comes begging to town

We're stuck between a rock
And a hard place
Between a rock and a hard place

This talk of freedom
And human rights
Means bullying and private wars and chucking all the dust into our eyes
And peasant people
Poorer than dirt
Who are caught in the crossfire with nothing to lose but their shirts

Stuck between a rock
And a hard place
Between a rock and a hard place

You'd better stop put on a kind face
Between a rock and a hard place

We're in the same boat
On the same sea
And we're sailing south
On the same breeze
building dream churches
With silver spires
And our rogue children
Are playing loaded dice

Give me truth now
Don't want no sham
I'd be hung drawn and quartered for a sheep just as well as a lamb

Stuck between a rock
And a hard place
Between a rock and a hard place
You'd better stop
Put on a kind face
Can't you see what you've done to me

Thursday, August 11, 2011

Lymph Node Study Shakes Pillar of Breast Cancer Care - NY Times Reprint from February 2011

Looking for a follow up / backlash to this published study reported on back in February of this year...

February 8, 2011
Lymph Node Study Shakes Pillar of Breast Cancer Care

A new study finds that many women with early breast cancer do not need a painful procedure that has long been routine: removal of cancerous lymph nodes from the armpit.

The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping the cancer from spreading or coming back.

Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in the nodes, the researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realization that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published. But more widespread change may take time, experts say, because the belief in removing nodes is so deeply ingrained.

“This is such a radical change in thought that it’s been hard for many people to get their heads around it,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, which is being published Wednesday in The Journal of the American Medical Association. The National Cancer Institute paid for the study.

Doctors and patients alike find it easy to accept more cancer treatment on the basis of a study, Dr. Morrow said, but get scared when the data favor less treatment.

The new findings are part of a trend to move away from radical surgery for breast cancer. Rates of mastectomy, removal of the whole breast, began declining in the 1980s after studies found that for many patients, survival rates after lumpectomy and radiation were just as good as those after mastectomy.

The trend reflects an evolving understanding of breast cancer. In decades past, there was a belief that surgery could “get it all” — eradicate the cancer before it could spread to organs and bones. But research has found that breast cancer can begin to spread early, even when tumors are small, leaving microscopic traces of the disease after surgery.

The modern approach is to cut out obvious tumors — because lumps big enough to detect may be too dense for drugs and radiation to destroy — and to use radiation and chemotherapy to wipe out microscopic disease in other places.

But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.

The new results do not apply to all patients, only to women whose disease and treatment meet the criteria in the study.

The tumors were early, at clinical stage T1 or T2, meaning less than two inches across. Biopsies of one or two armpit nodes had found cancer, but the nodes were not enlarged enough to be felt during an exam, and the cancer had not spread anywhere else. The women had lumpectomies, and most also had radiation to the entire breast, and chemotherapy or hormone-blocking drugs, or both.

The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years.

After the initial node biopsy, the women were assigned at random to have 10 or more additional nodes removed, or to leave the nodes alone. In 27 percent of the women who had additional nodes removed, those nodes were cancerous. But over time, the two groups had no difference in survival: more than 90 percent survived at least five years. Recurrence rates in the armpit were also similar, less than 1 percent. If breast cancer is going to recur under the arm, it tends to do so early, so the follow-up period was long enough, the researchers said.

One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact.

It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.

The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.

Dr. Armando E. Giuliano, the lead author of the study and the chief of surgical oncology at the John Wayne Cancer Institute at St. John’s Health Center in Santa Monica, Calif., said: “It shouldn’t come as a big surprise, but it will. It’s hard for us as surgeons and medical oncologists and radiation oncologists to accept that you don’t have to remove the nodes in the armpit.”

Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, said that by routinely taking out many nodes, “I have a feeling we’ve been doing a lot of harm.”

Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.

But Dr. Carlson said that some of his colleagues, even after hearing the new study results, still thought the nodes should be removed.

“The dogma is strong,” he said. “It’s a little frustrating.”

Eventually, he said, genetic testing of breast tumors might be enough to determine the need for treatment, and eliminate the need for many node biopsies.

Two other breast surgeons not involved with the study said they would take it seriously.
Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said: “It’s a big deal in the world of breast cancer. It’s definitely practice-changing.”

Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said surgeons had long been awaiting the results.

“In the past, surgeons thought our role was to get out all the cancer,” Dr. Estabrook said. “Now he’s saying we don’t really have to do that.”

But both Dr. Estabrook and Dr. Port said they would still have to make judgment calls during surgery and remove lymph nodes that looked or felt suspicious.

The new research grew out of efforts in the 1990s to minimize lymph node surgery in the armpit, called axillary dissection. Surgeons developed a technique called sentinel node biopsy, in which they injected a dye into the breast and then removed just one or a few nodes that the dye reached first, on the theory that if the tumor was spreading, cancer cells would show up in those nodes. If there was no cancer, no more nodes were taken. But if there were cancer cells, the surgeon would cut out more nodes.

Although the technique spared many women, many others with positive nodes still had extensive cutting in the armpit, and suffered from side effects.

“Women really dread the axillary dissection,” Dr. Giuliano said. “They fear lymphedema. There’s numbness, shoulder pain, and some have limitation of motion. There are a fair number of serious complications. Women know it.”

After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.

The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.

“Some prominent institutions wouldn’t even take part in it,” Dr. Giuliano said, though he declined to name them. “They’re very supportive now. We don’t want to hurt their feelings. They’ve seen the light.”