Grant: Project Grant

About 15% of breast cancers have already spread to the lymph nodes at diagnosis. In these cases, surgeons usually remove all the lymph nodes in the armpit using a procedure called axillary lymph node dissection (ALND). ALND causes long-term arm pain, stiffness or swelling in nearly half of patients. On average, 17 lymph nodes are removed, even though only 1 to 3 will contain cancer in up to 40% of cases. A newer approach called tailored axillary surgery (TAS) removes only lymph nodes are known or most likely to contain cancer, avoiding those that are healthy. On average only 4-8 nodes are removed, which may reduce the risk of arm symptoms and improve quality of life (QoL). However, this benefit has not been well-studied. We are planning a study involving patients with lymph node-positive breast cancer at 12 centres across Canada. Participants will complete surveys about arm and breast symptoms, physical function, emotional and social well-being and overall QoL. We will describe how common and how severe symptoms are, and how they change over 2 years after surgery. We will compare symptoms and QoL in patients who had TAS versus ALND. Most studies have focused on proving that TAS is safe and does not increase the risk of cancer recurrence or death. Our work is unique because it focuses on life after treatment from the patient perspective. If TAS causes fewer side effects than ALND, this would support offering it to more patients. Since TAS is still new and not widely used, we may be missing an important chance to reduce treatment-related side effects in survivorship.