Even a few cells make a difference. Too bad

In the last few years, pathologists (doctors who examine cancer specimens under the microscope) have become increasingly expert at detecting fewer and fewer cancer cells. Using special techniques, they can find just a few cancer cells in the lymph nodes of women who have had breast surgery and lymph node removal.

The problem has been what these few cells mean. Does it mean the cancer is more likely to come back and spread? Or, are they just some excess garbage that won’t cause harm?

Now the answer is in. In an article published in today’s (August 13, 2009) New England Journal of Medicine, Dutch researchers have found that these few cells are bad news. Women who had them and didn’t receive chemotherapy (not the standard of care and as I said, no one knew what these cells meant) were 50 percent more likely to have their cancer come back than women whose lymph nodes were free of any cancer cells.

But there is a small light at the end of the tunnel. If the women with the few cancer cells received some kind of therapy after surgery such as chemotherapy or hormone therapy, their chance of recurrence was much lower. In fact, it looks like it was the same as those without cancer cells in their lymph nodes.

Because no one wants chemotherapy after breast cancer surgery, for many oncologists the standard of practice has been not to treat women with just a few cancer cells in their lymph nodes. Now that will have to change.

Too bad, but good thing we know what to do now.