Sequelae of axillary lymph node dissection in older women with stage 1 and 2 breast carcinoma

Abstract

BACKGROUND. There are few data on the long-term sequelae of axillary dissection among older breast carcinoma patients. We describe the impact of axillary dissection in a cohort of older women. METHODS. A longitudinal cohort of 571 patients with Stage 1 and 2 breast carcinoma, 67 years and older, diagnosed between 1995 and 1997 from 29 hospitals in five regions, and followed for 2 years. Data were collected from patients and medical charts. The primary outcome was posttreatment quality of life. Generalized estimation equation longitudinal modeling was used to evaluate the outcome, controlling for baseline function, comorbidity, age, clinical status, and other factors. RESULTS. Sixty percent of women reported arm problems at some time in the 2 years after surgery. The cumulative risk of having arm problems 2 years posttreatment was three times higher (95% confidence interval 1.94-4.67) for women who underwent axillary surgery compared with women without axillary surgery, controlling for covariates. The effects of having axillary dissection and arthritis were multiplicative 2 years postsurgery. Arm problems were, in turn, the primary determinate of lower physical and mental functioning (P ϭ 0.0001 and 0.04, respectively), controlling for other factors. Undergoing axillary dissection did not lessen fears about recurrence. CONCLUSIONS. Arm problems after axillary dissection have a consistent negative impact on quality of life, suggesting that the risks may outweigh the potential benefits in this population.

Breast cancer in elderly women (≥80 years): variation in standard of care?

“…Unfortunately, large national trials include only small numbers of these older women, and the data that is available suggests that these women often receive less than the standard of care [3-6] and have worse outcomes because of it [1, 7-9]. Other data propose that older women may, in fact, do equally well without aggressive treatment [10-12] or that standard treatments cause more complications in elderly patients [13]. Much of the literature defines “elderly” very broadly, including women as young as 65 or even excluding women over 80 from studies focused on older breast cancer patients [10].…”

Surgery for Breast Cancer

“…333 Nevertheless, the impact of axillary dissection may be additive to preexisting arthritis and can adversely affect quality of life. 392 Are there any postoperative complications specific to mastectomy?…”

The influence of aging on the early detection, diagnosis, and treatment of breast cancer

“…Axillary node dissection is also more likely to be omitted in the elderly [25]. Mandelblatt et al [26] reported a higher frequency of arm-related problems with resultant decreased function and quality-of-life indices in women over the age of 67 who had axillary dissection. Sentinel node biopsy (SLN) is an attractive option for the elderly, sparing surgical morbidity and lymphedema.…”