Women who undergo axillillary node surgery for breast cancer are much more likely to develop chronic pain, according to a study published in the Canadian Medical Association Journal (CMAJ).
“Ten-year survival rates for breast cancer patients are now around 83%, but up to 60% of women who undergo surgery as part of cancer treatment, may develop chronic pain,” said senior author Jason Busse, MD, He Michael G. DeGroote Institute for Pain Research and McMaster University, Hamilton, Ontario.
The researchers conducted a systematic review that analysed 30 observational studies that enrolled 20,000 women undergoing surgery for breast cancer. Analysis of the data suggested that disruption of sensory nerves in the axilla as lymph nodes are removed is associated with the development of chronic pain.
“We cannot be certain that efforts to spare nerves during axillary surgery for breast cancer will prevent development of chronic pain,” said Dr. Busse. “Although we found a 21% increase in risk for chronic post-surgical pain associated with axillary node surgery, nerve sparing may not always be possible, and when possible may not reduce the risk of chronic pain as much as the current evidence suggests.”
Changes are being made around the world to change treatment, said co-author Susan Reid, MD, McMaster University, and the Michael G. DeGroote School of Medicine.
“Current standards in axillary surgery have already undergone a significant shift towards sentinel node biopsy, which lessens all potential complications for many patients,” she said.
Dr. Busse noted that large, well-conducted randomised trials are needed on the issue.