Date: 20 October 2017
Researchers working on the first ever UK-led international surgical breast cancer clinical trial are paying tribute to hundreds of women who are helping them investigate the potential over-treatment of early breast cancer.
The NIHR-funded POSNOC trial is looking at the armpit treatment given to women who are diagnosed with early stage breast cancer when the cancer has spread to the lymph nodes under the arm. Currently statistics show that the cancer returns at the same rate in women who are given armpit treatment and in women who have not had armpit treatment.
The trial is trying to establish if armpit treatment is of benefit to women with cancer spread to one or two lymph glands who are receiving chemotherapy or hormone treatment.
At present, normal treatment for early breast cancer patients with lymph node spread is either surgical removal of the armpit lymph nodes or radiotherapy. POSNOC is recruiting 1900 women in the UK, Australia and New Zealand to be randomised into either armpit treatment or not, to find out whether the extra surgery and/or radiotherapy adds any additional benefit to treating the armpit lymph nodes with drugs. This is important as 1 in 5 women who undergo armpit treatment may develop incurable lymphoedema – swelling of the arm – that can seriously affect their quality of life after treatment.
School teacher Fiona McOwan from Dunfermline in Scotland was diagnosed with early stage breast cancer with lymph node spread in 2007. Fiona said: “I had been told about the risk of developing lymphoedema following breast cancer surgery with node removal, and was shown a photograph of a swollen arm by my breast care nurse. In May 2007 I began to experience a feeling in my lower left arm that was between an ache and a bruise. I did not associate this with lymphoedema until I read an article in Vita, the magazine of Breast Cancer Care, on all the possible indicators of the condition. There it was – an aching or bruised feeling in the arm!
“I was subsequently diagnosed with lymphoedema in early June by a specialist physiotherapist in NHS Fife. Since then I have worn my compression sleeve daily and practised Simple Lymph Drainage (SLD) every night. I take good care of my skin, particularly in sun, and am now considered to be under self-management. I think the POSNOC trial is particularly interesting in terms of the decisions that can be made about removal or not of ancillary lymph nodes and the full implications of informed consent.”
Chief Investigator on the POSNOC trial, Associate Professor Amit Goyal, from the Royal Derby Hospital said: “No woman should undergo unnecessary treatment that may cause debilitating side effects like arm swelling. Arm problems after removing the lymph glands or giving radiotherapy are often a persistent reminder when the cancer has long gone. Women want to move on and draw a line once they have finished cancer treatment. Towards this, the POSNOC study will take us a step closer to optimise breast cancer treatment and find out whether we can treat the lymph glands by drugs rather than by removing them or giving radiotherapy. Together, we can #makelymphoedemahistory
One in five women diagnosed are found to have cancer in lymph nodes under the arm so the trial has wide implications for future treatment protocols. So far more than 850 women have been recruited to help the POSNOC study but a further 1,000 are needed to fulfil the trial’s remit and deliver a robust analysis of the benefit, or not, of lymph node surgery and radiotherapy.
For more details, please see the project page.
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