By Jennifer Litton, M.D.
Dr. Giuliano reported the results from ACOSOG study Z0011. This study evaluated the need for further axillary lymph node dissection in women who had up to three sentinel lymph nodes removed during surgery, had a positive lymph node, but did not go on to have further lymph node surgery. The researchers reported no significant differences in local disease recurrence or in overall survival.
This may be the beginning of a major shift in how we address and treat lymph nodes during surgery for women who have biologically low-risk tumors and are treated with whole-breast radiation that also encompass the lymph node area.
Additionally, Dr. Albain reported on potential causes of racial survival disparities in the SWOG 8814 study. Historically, African-American women have been reported to have worse breast cancer outcomes and overall survival after a diagnosis of breast cancer. This analysis tried to evaluate if there was a biological difference in the tumors by race when evaluated in a controlled clinical trial setting.
The researchers looked at postmenopausal women with ER-positive tumors. Nine percent of the women involved in the above trial were African-American. All trial participants had the same treatment and scheduled follow-ups. Additionally, the researchers used the Oncotype DX test to estimate risk of recurrence by using recurrence scores (RS). There was no significant difference in the distribution of recurrence scores, although there was a trend to higher recurrence scores in African-American women.
Chemotherapy worked equally well in African-American women compared with the rest of the women who participated in the study. The outcomes did, however, show differences in recurrence and survival when controlled for all other factors. The researchers noted a difference with higher ki-67 - a marker of proliferation, or how fast a tumor divides - in the tumors of African-American breast cancer patients. Therefore, further evaluations of these differences in a controlled clinical trial setting need to be done.