Did you know…

Despite experts not recommending sentinel lymph node biopsies, between 17% and 40% of women with DCIS currently undergo this unnecessary procedure that comes with serious side effects.

Risks of sentinel lymph node biopsies:

Pain, wound infection, and lymphedema, a painful condition that can restrict a woman’s arm movements.

Patient advocate Ann Fonfa, founder of the Annie Appleseed Project wrote an article: Is Lymph Node Removal with Cancer Surgery Really Necessary?

Lymphedema is Not Just an “Unfortunate Side Effect” of Lymph Node Removal

“Imagine a skin burn where ordinarily the lymph cells rush to the area. In a sluggish lymphatic system − one that has sustained damage − there is no “rush” involved. The clogged or swollen area does not easily allow the appropriate immune cells to reach the affected area, and healing can take much longer.

People with leg or lower body lymphedema may find walking difficult or painful. Some people may not be able to pick up their children or grandchildren due to weakness and swelling in their arms. Over time, sensations in the areas may be reduced. Anyone who has had lymph nodes removed is at much higher risk of serious infections like cellulitis, which can lead to sepsis.

And lymphedema can occur at any time. There is no time limitation on the development of lymphedema (the swelling and visible sign of damage to the lymphatic system). And current treatments are only variations on temporary reduction in swelling.”

New research by the Yale School of Public Health found older women, (age 67-94) with DCIS gain no long-term benefit from a sentinel lymph node biopsy to see if the cancer has spread.

Long-term impact of sentinel lymph node biopsies:

• Did not reduce the likelihood of dying from breast cancer
• Did not decrease the chances of developing invasive breast cancer
• Did not decrease the number of additional cancer treatments

So why do so many women undergo sentinel lymph node biopsies?

“Proponents of sentinel lymph node biopsy cite concerns that occult micro-invasive disease within the DCIS may not be detected via other methods. Also, the sentinel lymph node biopsy is included in the Centers for Medicare & Medicaid merit-based incentive payment system for invasive breast cancer,” Shi-Yi Wang, M.D., Yale School of Public Health associate professor and the study’s lead author said. “This might create a financial incentive for providers to perform these biopsies even for non-invasive conditions.”

“Some surgeons say that sentinel node biopsies are no big deal, but I disagree. All interventions have consequences. More is not better. More is just more, and in this case, more is worse.” – Laura Esserman, professor of surgery and radiology at UCSF and director of their Breast Care Clinic (not involved in the study).

Dr Wang, cautioned that the findings may not be generalizable to young women and that more research is also needed to determine if sentinel lymph node biopsies benefit patients with a high-risk type of DCIS.