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Micrometastases in Breast Cancer- Should You Care?

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“Micrometastatic lymph node involvement in itself should not be an indication for adjuvant chemotherapy in breast cancer patients.”

What are micrometastases and why should they matter to newly-diagnosed breast cancer patients? Micromets, according to the wiki link definition below, are tiny bits of breast cancer that come from the original tumor site.

The question being studied by the second linked study is whether or not micromets found in the “sentinel lymph node” tell you anything about your therapy or prognosis.

According to the study, no, “Micrometastatic lymph node involvement in itself should not be an indication for adjuvant chemotherapy in breast cancer patients.”

These are stunningly different ideas than what the medical profession has believed for years.  On one hand, it seems like extremely good news.  Those with metastases that are not above 2mm in size may be able to expect a much better outcome than previously believed, as long as they take systemic therapy.  However, it also says that those with no metastases also benefit from systemic therapy. 

I am not sure how this would work for treatment.  Could systemic therapy (presumably chemotherapy and/or endocrine therapy) be recommended for everyone? To put it differently, there are a host of evidence-based, non-toxic therapies that are shown to be cytotoxic to breast cancer. Consider evidence-based nutrition, supplementation, and lifestyle therapies-all that can fight breast cancer.

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For more information on non-conventional therapies to reduce the risk of breast cancer relapse scroll down the page, post a question or a comment and I will reply ASAP.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Micrometastasis

Micrometastasis is a form of metastasis (the spread of cancer from its original location to other sites in the body) in which the newly formed tumors are too minuscule to be detected [1]

Adjuvant chemotherapy and adjuvant radiotherapy are directed at killing any micrometastases, thus preventing relapse (regrowth of cancer) and the (likely) death of the patient. Early detection of micrometastases could identify the patients who are most (and least) likely to benefit from adjuvant therapy.[2]

“BACKGROUND: The prognostic meaning and thus indication for adjuvant therapy of lymphogenic micrometastases in breast cancer patients is still under debate.
RESULTS-At the end of follow-up, 53 patients had died and 64 had recurrent disease. Compared with (p)N(0) and following adjustment for possible confounders, including adjuvant systemic treatment, overall survival was not significantly different for (p)N(1micro) while significantly worse for (p)N(1a) and (p)N(>or=1b) {hazard ratio (HR) [95% confidence interval (CI)]: 0.59 [0.14-2.58], 4.31 [1.85-10.01], 10.66 [4.04-28.14], respectively}. Likewise, disease-free survival was not significantly different for (p)N(1micro) and worse for (p)N(1a) and (p)N(>or=1b) (HR [95% CI]: 1.43 [0.67-3.02], 2.79 [1.37-5.66], 7.13 [3.27-15.54], respectively). Distant metastases were more commonly observed in the (p)N(1micro) than in the (p)N(0) group, but still not as common as in the (p)N(1a) or (p)N(>or=1b) group (HR [95% CI]: 4.85 [1.79-13.18], 10.34 [3.82-28.00], 23.25 [7.88-68.56], respectively).
 
CONCLUSION: Although the risk of distant metastases was higher in patients in the (p)N(1micro) than in the (p)N(0) group, no statistically significant differences were observed in overall or disease-free survival between (p)N(0) and (p)N(1micro). Micrometastatic lymph node involvement in itself should not be an indication for adjuvant chemotherapy in breast cancer patients.”

Effect of occult metastases on survival in node-negative breast cancer.

“Retrospective and observational analyses suggest that occult lymph-node metastases are an important prognostic factor for disease recurrence or survival among patients with breast cancer. Prospective data on clinical outcomes from randomized trials according to sentinel-node involvement have been lacking…

Occult metastases were detected in 15.9% (95% confidence interval [CI], 14.7 to 17.1) of 3887 patients. Log-rank tests indicated a significant difference between patients in whom occult metastases were detected and those in whom no occult metastases were detected with respect to overall survival (P=0.03), disease-free survival (P=0.02), and distant-disease-free interval (P=0.04). The corresponding adjusted hazard ratios for death, any outcome event, and distant disease were 1.40 (95% CI, 1.05 to 1.86), 1.31 (95% CI, 1.07 to 1.60), and 1.30 (95% CI, 1.02 to 1.66), respectively. Five-year Kaplan-Meier estimates of overall survival among patients in whom occult metastases were detected and those without detectable metastases were 94.6% and 95.8%, respectively.

CONCLUSIONS: Occult metastases were an independent prognostic variable in patients with sentinel nodes that were negative on initial examination; however, the magnitude of the difference in outcome at 5 years was small (1.2 percentage points). These data do not indicate a clinical benefit of additional evaluation, including immunohistochemical analysis, of initially negative sentinel nodes in patients with breast cancer. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00003830.).

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