Is more always better? Just because we can do something, should we? Dr. Tari King, chief of the Division of Breast Surgery at Brigham and Women’s Hospital, argues that when physicians can spare patients invasive procedures every effort should be made to do just that.
Many women with breast cancer will often have evidence of cancer spread to the lymph nodes in their armpit, also known as the axilla. In the past, the standard treatment was to perform a complete axillary lymph node dissection, an extensive surgery in the armpit that can lead to significant swelling in the affected arm. The incorporation of pre-operative, or neoadjuvant, chemotherapy enables physicians to attempt to eradicate the disease in the axilla, in turn allowing for a much smaller and less invasive lymph node surgery.
Clinical trials are ongoing to determine whether noninvasive imaging studies, such as ultrasound, may identify women who can forgo surgery in the axilla altogether. Other advances, such as the use of specialized molecular tests, have allowed physicians to identify patients that may not need chemotherapy or radiation therapy following surgery.
Oncologists are always working to understand how best to treat those they care for, but treating patients optimally doesn’t always mean more, more, more! Why use a military-grade flamethrower to start a small campfire when a simple match would accomplish the same task, and with much less potential for unwanted effects?