Hundreds of women in breast cancer trial

By MARTIN JOHNSTON health reporter

Hundreds of New Zealand women are to take part in a major clinical trial designed to reduce the complications of breast cancer surgery.

Breast cancer is a big killer of New Zealand women, with around 2200 new cases and more than 600 deaths each year.

The five-year trial of up to 1100 women in New Zealand and Australia will test a new technique that aims to minimise the need to cut out underarm lymph nodes.

Dr John Simpson, a spokesman for the Royal Australasian College of Surgeons, which is overseeing the trial, said the technique was a major advance in surgical management of breast cancer.

Health Minister Annette King is scheduled to announce today the start of the New Zealand part of the study, to be led by North Shore Hospital.

The study will compare women receiving the new technique, called sentinel node biopsy, with those given traditional treatment.

Women with early stage cancer who have breast surgery now routinely have most of the lymph nodes removed from the adjacent armpit.

Cancer can spread through the body's lymphatic system. The condition of the underarm nodes is crucial to predicting the course of the disease and the presence of cancer there is the key to therapy.

But in 70 per cent of patients, the removed glands are free of cancer. Complications of their removal include numbness, reduced shoulder mobility and swelling of the arm.

The new technique involves the injection around the tumour of two substances.

One is a blue dye that the surgeon can see through an underarm incision. The other is a radioisotope substance that is detected with a gamma probe. Only nodes to which these substances have drained are removed.

In the trial, all women will have their breast tumours treated in the standard way and undergo a sentinel node biopsy.

One randomly selected group will have most of their armpit lymph nodes removed. The other will retain them if no cancer was found in the sentinel nodes.

The coordinator of the trial, North Shore breast surgeon Dr Richard Harman, said the technique would be carried out by surgeons assessed as competent in the procedure.

The chairwoman of the Breast Cancer Foundation medical committee, Dr Belinda Scott, said last night that this was important because the technique was difficult to carry out.

"There are two schools of thought: that the trial has already been done and the technique should be offered and the other school that says let's be more careful."

The college says early results from overseas trials are encouraging, but final results are not expected from the European and American trials for at least five years.

nzherald.co.nz/health