SNAC 3 years

Sentinel-lymph-node biopsy reduces arm swelling after breast cancer surgery

New results from the SNAC trial show that women with early breast cancer who have a sentinel-lymph-node procedure have less subsequent arm swelling over 3 years than women who have the older, more invasive clearance of lymph nodes.

Removal of the majority of nodes had been the standard way of detecting spread of cancer cells, but this has risks, including arm swelling, pain, and movement limitation, which can last for many years.

The SNAC trial was conducted as a response to the patients' complaints and comments about these symptoms. Breast surgeons from the Royal Australasian College of Surgeons in collaboration with the CTC trialled the new form of surgery: injecting dye into the tumour, tracking the movement of the dye and removing only the first armpit lymph node where the dye was seen (the sentinel node). If there was no tumour in that node, the surgeon concluded that the cancer had not spread.

1088 women with early breast cancer in Australia and New Zealand entered the trial. Half had sentinel-lymph-node based management and half had routine axillary clearance.

The patients have since had regular arm measurements and assessments and have provided information on their quality of life. Although the benefit of the sentinel-lymph-node operation for arm swelling was still apparent, by 3 years the groups were the same for other symptoms such as arm movement.

Patients are still being followed up, and the analysis of 5 years of data will soon be published. The investigators have also been recruiting women with larger tumours and multiple tumours for the SNAC2 trial. They aim is to find out whether the risk of cancer recurrence is the same after sentinel-node biopsy as after full node clearance. If so, the sentinel-node procedure will become standard practice for all women with early breast cancer.

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22 October 2014