Receiving a diagnosis of breast cancer can be an overwhelming experience. A frequently asked question at an early stage is: “Do I genuinely need lymph node surgery?” Historically, evaluating the lymph nodes has constituted a crucial component of breast cancer treatment. Nevertheless, contemporary research — including our recent study — indicates that certain patients might be able to safely avoid this step, depending on their individual risk.
What is lymph node surgery?
In early breast cancer, surgeons often perform a procedure called sentinel lymph node biopsy (SLNB). This involves removing a small number of lymph nodes from the armpit to check if cancer has spread. It is much less invasive than removing all lymph nodes, but it is still surgery. Like any procedure, it carries some risks, including:
- Arm swelling (lymphedema)
- Numbness or discomfort
- Fluid collection (seroma)
Although these complications are not common, avoiding unnecessary surgery is always beneficial.
Why are doctors trying to avoid it?
Breast cancer treatment is changing. The focus is now on:
- Personalised care
- Minimising unnecessary procedures
- Maintaining excellent cancer outcomes
Large international studies have shown that some low-risk patients can safely skip lymph node surgery, without affecting survival. However, the challenge is identifying who is truly low risk.
What did our study investigate?
In our study, we analysed over 1,000 women with early breast cancer treated in Australia. All patients had no obvious lymph node involvement on clinical examination or ultrasound. We wanted to see whether a risk prediction tool could help identify patients who might safely avoid lymph node surgery.
What is a risk prediction tool?
We used a widely known tool called the MSKCC nomogram. This tool estimates the chance of cancer being present in the lymph nodes based on several factors, including:
- Tumour size
- Tumour type and grade
- Hormone receptor status
- Patient age
Instead of a simple “yes or no,” it gives a percentage risk, allowing for more personalised decisions.
What did we find?
1. Some patients can safely avoid surgery
Using this risk-based approach:
- About 1 in 3 patients (29%) could avoid lymph node surgery
- The chance of missing cancer in the lymph nodes was low (around 10%)
2. Skipping surgery in more patients increases the risk
Other approaches, based on large clinical trials, allowed more patients to avoid surgery:
- Up to 46–67% of patients avoided surgery
- But this came with a higher chance of missing cancer in the nodes
This highlights an important balance: avoiding surgery versus missing an important disease.
3. A personalised approach may be the best path forward
Rather than applying the same rule to everyone, a risk-based approach allows:
- Individualised decision-making
- Better balance between safety and avoiding surgery
- Flexibility depending on the clinical situation
What does this mean for you?
Not all breast cancers behave the same way — and not all patients need the same treatment. Your doctor will consider:
- Your tumour characteristics
- Your overall risk
- Whether lymph node results will change your treatment
In some patients, avoiding lymph node surgery may be reasonable. In others, it remains an important part of the treatment.
Important points to remember
- Lymph node surgery is still the current standard
- Some patients may safely avoid it
- Decisions must be personalised
- Ongoing research is improving how we select patients
Related Articles
You may also find these articles from Mr Justin James helpful:
- Understanding Breast Density: What Your Mammogram Means — How mammogram findings affect your breast cancer risk assessment.
- Is HRT Safe? Understanding the Breast Cancer Risk — Evidence-based guide to HRT and breast cancer.
- Fibroadenoma: What You Need to Know — Understanding common benign breast lumps.
Final message
Breast cancer care is becoming more tailored to each individual. The goal is simple: provide the right treatment — while avoiding what you don’t need.
If you have been diagnosed with breast cancer, speak with your doctor about your individual risk and whether lymph node surgery is necessary in your case.
This article is based on our peer-reviewed publication: Nomogram-guided sentinel node strategy in early breast cancer: Evaluation and comparison with current de-escalation approaches
Read the full study: Nomogram-guided sentinel node strategy in early breast cancer (ScienceDirect)
