Will All Lymph Node-Positive Breast Cancer Patients Need Chemotherapy?

Do Lymph Node-Positive Breast Cancer Patients Need Chemotherapy?

lymph node-positive breast cancer patientsAbout 40% of women diagnosed with breast cancer have cancer in their lymph nodes. Lymph node positive breast cancer means cancer has spread from the breast to the lymph nodes located in the armpit area.

According to our Medical Director Dr. Harness, “Historically, this was really an important factor in determining if patients needed chemotherapy or not.” The size of the cancer, the grade of the cancer, but particularly, if the cancer was involving lymph nodes that meant that you would automatically get chemotherapy.

With advancements in breast cancer research, we are finding that this isn’t exactly true. Find out why not all lymph node positive breast cancer patients need chemotherapy.

Transcript

Jay K. Harness:  Will all lymph node positive patients benefit from chemotherapy? Not exactly.  Let me share some more about this important subject.

Lymph node positive breast cancer that means the cancer has spread from breast itself to the lymph nodes in the armpit area.  Now, historically, this was really an important factor in determining if patients needed chemotherapy or not.  Historically, the size of the cancer, the grade of the cancer, but particularly, if the cancer was involving lymph nodes that meant that you would automatically get chemotherapy and in premenopausal women probably one of big benefits of chemotherapy has been knocking out the ovaries at least temporarily, so the question then becomes do all patients who are lymph node positive have to have chemotherapy and as I have said, not exactly. 

This is particularly true in the estrogen receptor-positive patients who may have anywhere from one to three positive lymph nodes.  The Oncotype DX test has been validated for lymph node positive estrogen receptor-positive patients with a maximum of three positive lymph nodes.  Now, all of us in the field have known for years that chemotherapy may not work that well in estrogen-receptor positive patients, but we have given the chemotherapy anyway.  Now for patient who is triple negative or HER2-neu positive or things like that, no question that chemotherapy is really important, but in the lymph node positive patients, the estrogen-receptor positive patients, the Oncotype score, the recurrence score can help us in start to differentiate who is going to benefit from adjuvant chemotherapy. 

With a low risk Oncotype score, the validation studies that have been done showed no benefit of adjuvant chemotherapy up to three positive lymph nodes being involved and in the high-risk patients, those who have a high risk recurrence score, there is no question that chemotherapy is needed and that the patients benefit from it.  With the intermediate risk score in the middle, then here other clinical factors will come into play determining the role of adjuvant chemotherapy, so the bottom-line of all this says if you are lymph node positive, do not automatically think that you need chemotherapy whether you are pre or postmenopausal, make sure that an Oncotype test is done if you are estrogen receptor-positive.  You may be able to avoid unnecessary chemotherapy, in particular chemotherapy that may not actually benefit you.