NODE-POSITIVE EARLY BREAST CANCER
A healthy 55-year-old woman had a lumpectomy (negative margins) and
axillary node dissection for a 2.5 cm tumor in the upper outer quadrant of
the left breast, with three positive lymph nodes. The tumor was positive for
both estrogen and progesterone receptors. She comes to the gynecologist’s
office wanting an opinion about further therapy.Breast-conserving therapy with a wide excision (lumpectomy), axillary
dissection (or sentinel node biopsy), and radiation therapy are considered the
preferred treatment for most patients with stage I or II breast cancer.
In patients at moderate or high risk of developing systemic metastasis, it is
preferable to give adjuvant therapy, beginning with chemotherapy followed by
radiation therapy.
This patient has a high risk of recurrence because of the presence of lymph node
metastasis, and it would be inappropriate to withhold further therapy. Another
high risk factor here is that her tumor is larger than 1 cm.
A large number of prospective randomized trials, as well as recent overviews and
meta-analysis of adjuvant systemic therapy, have determined that both
chemotherapy and tamoxifen therapy reduce the odds of recurrence in breast
cancer patients. A few randomized clinical trials and the overview of meta-
analysis of randomized clinical trials have suggested that the combination of
chemotherapy and tamoxifen is superior to chemotherapy alone or tamoxifen
alone in postmenopausal patients with node-positive breast cancer. Women with