Sat, Feb 28, 2004 - Page 2 News List

Breast cancer side-effects could be reduced: doctors

CONTROVERSY Sentinel node biopsies can tell whether cancer cells have spread from the breasts to the lymph nodes but the procedure is not yet widely accepted here


New techniques for the treatment of breast cancer have met with controversy, but if the techniques are implemented they could reduce the number of side-effects from surgery, according to the Breast Cancer Society of Taiwan yesterday.

"Traditionally, when patients are diagnosed with breast cancer in its first stage or beyond, doctors in Taiwan will remove the tumor and surrounding lymph nodes, even if cancer cells have not spread that far," said Dr. Yu Jyh-cherng (俞志誠) of the National Defense Medical Center.

Because fluids flow from the breasts to surrounding lymph nodes, the cancer can spread to a patient's lymph nodes. According to Yu, the cancer cells spread to sentinel nodes first, which is why biopsies of the sentinel nodes can be an indication of whether the cancer has spread.

However, Yu said that while doctors have been performing sentinel node biopsies over the past six years, the procedure has yet to be generally accepted and is not widely available.

"In the first stage of breast cancer, only about 20 to 25 percent of a patient's cancer cells spread to the lymph nodes. In the second stage, it's about 40 to 50 percent," Yu said.

The removal of surrounding lymph nodes can lead to painful side-effects, such as numbness in the shoulders and back, swollenness and chronic inflammation.

Liu Tse-jia (劉自嘉), president of the Breast Cancer Society of Taiwan, said that while biopsies could be used to determine whether to remove lymph nodes, not all doctors were willing to perform the procedure.

"Because the sentinel node biopsy is not covered by the National Health Insurance, hospitals that offer the test either assume the costs themselves or charge patients," Liu said.

Liu estimated that the biopsies cost around NT$6,000 each.

Also, Yu explained that in most cases, diagnosis of cancer cells in the sentinel node indicated that the cancer had spread to surrounding lymph nodes, but he said there was a 2 percent chance of a "false negative," in which cancer cells are not identified in the sentinel nodes, but exist in surrounding lymph nodes.

Most doctors chose to remove all surrounding lymph nodes instead of running the risk of a false negative.

Liu said that while Taiwan did not have a sufficient number of cases from which to draw any reasonable conclusions, the number of patients in Singapore who saw a recurrence of cancer within five years as a result of failure to remove surrounding lymph nodes was under 10 percent.

"Even if you later discover that cancer cells have spread to lymph nodes and consequently go back to the hospital for more surgery, the survival rate will be about the same," said Dr. Chiun-sheng Huang (黃俊升) of National Taiwan University Hospital, who is secretary-general of the society.

"The bottom line is that patients have to choose whether they want to have the sentinel biopsy performed. But they should be offered the choice," Liu said.

Liu said that it was up to medical associations to promote the acceptance of the biopsies among doctors and the Department of Health.

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