Treatments offer promise for breast cancer patients
By Adam Smeltz
Published: Saturday, Jan. 18, 2014, 9:10 p.m.
Breast cancer sapped Layla Banihashemi's energy, her health and her comfort.
Yet the disease and its treatments did not claim her lymph nodes, the illness-fighting glands that surgeons once took from at least half of women with the cancer.
Removing the nodes often causes lymphedema, a long-feared swelling of the limbs that incapacitates thousands of women. Researchers say that problem is lessening as new treatments keep the glands intact.
“The fact that I was able to keep my breast, that I was able to keep my lymph nodes — all those things together gave me the greatest peace of mind,” said Banihashemi, 33, of Squirrel Hill, a neuroscience researcher at the University of Pittsburgh. “I really was able to have the minimal amount of suffering.”
Banihashemi, diagnosed with breast cancer a year ago, said she rebounded without major complications from chemotherapy and a lumpectomy in Magee-Womens Hospital of UPMC.
Researchers estimate that as few as 15 percent of patients endure the often painful lymphedema, down from 30 percent during the past 15 years.
Historically, half of breast cancer patients battled lymphedema as doctors routinely removed breasts, lymph nodes and as much tissue as they could, said Dr. Stanley Rockson, director of the Stanford Center for Lymphatic and Venous Disorders at Stanford University.
Most women have more than a dozen of the underarm nodes, which can host cancerous cells when breast cancer flourishes.
The glands usually act as filters for the immune system. Removing them can affect the flow of lymph fluid, leading to chronic buildup of liquid that makes limbs balloon. Patients struggle with higher risk of infections, worry about self-image, and lose flexibility in hands and wrists.
“No question, women are afraid when they hear the term ‘lymphedema.' That sets the alarm off to say, ‘How can I limit that risk?' ” said Dr. Thomas B. Julian, division director for breast surgical oncology in the Allegheny Health Network.
He said the condition can inhibit daily tasks, force breast cancer survivors to wear cumbersome elastic garments, and complicate air travel because of air pressure changes.
For some survivors, the problem emerges years after doctors remove the lymph nodes.
Naomi Howard, 57, of Hampton wears a compression sleeve and fingerless glove to reduce swelling in her right arm. The condition has no cure.
“There are women who have what I call tree-trunk arms,” said Howard, who was diagnosed in April 2009. She said she tries to shift heavier loads to her left arm and carries a lighter purse, aware that her swelling could worsen.
“It's mine. I have it forever,” said Howard, who is undergoing chemotherapy because her cancer recurred in 2012. “My goal is just to keep my arm from swelling and blowing up.”
Though some women can't avoid lymphedema, studies during the past several years have helped doctors alter standard treatments so they only partially remove lymph nodes or sometimes keep them in place, said Dr. Gretchen M. Ahrendt, co-director of the UPMC Comprehensive Breast Cancer Program. She said many patients assume doctors will remove their underarm lymph nodes, though surgeons can target and take out only a few cancerous nodes.
A national study led by Julian, a senior surgical director at the National Surgical Adjuvant Breast and Bowel Project based at Allegheny General Hospital, helped expand the targeted approach. He said it cuts not only lymphedema risk but overall arm dysfunction, buoying quality of life for women.
Doctors offer most patients a lymph node biopsy that typically prevents draconian surgeries. “We're working now even to minimize those, too,” Julian said.
In the meantime, extracting select lymph nodes is not a universal fix. Whether a patient can keep nodes hinges on the type of cancer and how early it's detected.
Banihashemi carried a form known as HER2-positive, which appears in only 15 percent of breast cancer patients but is treatable with chemotherapy before surgery, said Dr. Barry C. Lembersky, a UPMC medical oncologist.
“We believe in the concept of pre-operative chemotherapy in order to minimize surgery,” including surgery around the lymph nodes, said Lembersky, who advised Banihashemi. She is among more than 300,000 women nationwide diagnosed with breast cancer in 2013, according to American Cancer Society estimates.
Ahrendt said treatment advancements could foreshadow steeper declines in the rates of lymphedema, which she ranked among the biggest worries for breast cancer survivors. She said early cancer detection can make node removal less likely.
“The real crime is getting lymphedema when your lymph nodes are negative” for cancer, said Dr. V. Suzanne Klimberg, a breast cancer surgeon who leads the Society of Surgical Oncology. “If I had positive nodes, I could put up with lymphedema; maybe I needed to have them removed. But if not, that feels really wrong because I didn't need to take them out in the first place.”
Adam Smeltz is a Trib Total Media staff writer. Reach him at 412-380-5676 or email@example.com.
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