Shattering My Lymphedema Schema

One definition of schema is a structured cluster of pre-conceived ideas. A recent clinical investigation of breast cancer and lymph node removal repudiates the time-honored ideas of many in the medical field that lymph node removal prevents cancer recurrence or improves survival.

The study, made public in early February, 2011, suggests that many women with early-stage breast cancer no longer need to have cancerous lymph nodes removed from their armpit. Conducted at the University of Texas M.D. Anderson Cancer Center and more than 100 other sites, the study found that taking out cancerous lymph nodes from a certain subset of women does not change their treatment plan, improve survival or make the cancer less likely to recur.

The results would seem to apply to women whose condition is like those in the study: stage T1 or T2 tumors (less than two inches across), no palpable lymph nodes, no metastases to other parts of the body and no more than two positive lymph nodes found in the sentinel node biopsy. Of course, the ultimate decision must be made in consultation with the treating surgeon and oncologist.

Many experts predict that this discovery, combined with earlier studies of a similar nature, will change medical practice for many patients. According to the February 8, 2011 New York Times article reporting the finding, some centers have already acted on the new information. For example, Memorial Sloan-Kettering Cancer Center in New York City changed its practice in September 2010, because doctors knew the study results before they were published. But, like adoption of the sentinel node biopsy procedure more than a decade ago, more widespread change in practice will take longer, due to the deeply held belief that removing more lymph nodes is beneficial.

It's important to remember that a life-long risk of lymphedema exists even after only a few nodes are taken for sentinel node biopsy. However, that risk is much lower than when many nodes are removed.

As a lymphedema survivor of 14 years, I have witnessed the dramatic improvement in more conservative node-removal surgery since 1996, when I had 14 nodes removed, all negative for cancer. I applaud the results of these advancements, even though I personally will not benefit from them. If they lead to practice changes, new breast cancer patients will no longer need to endure the pain and disabling side-effects of further lymph node removal and face further risk of developing lymphedema. After all, I--along with countless other women-- benefited from the now-decades-old studies that disproved the necessity for radical mastectomies.

Brava to the women who volunteered to participate in these ground-breaking clinical trials. I'm happy to shed my schema on treatment of lymphedema. It's welcome, and it's a relief.

The author's first book, "Mourning Has Broken: Reflections on Surviving Cancer" (Xulon Press, 2008) recounts her personal journey through two bouts with breast cancer. Her second book, a fanciful poetic look at breast cancer, is entitled "The Pebble Path: Returning Home from a Forest of Shadows" (Outskirts Press 2010).

She is an American Cancer Society volunteer, a breast cancer and lymphedema patient-advocate, blogger, and speaker.