Understanding Lymph Node-Positive Breast Cancer (Stage I-IIIA)

If you have been recently diagnosed with early-stage invasive breast cancer, characterized as Stage I to IIIa, with lymph node involvement, you are most likely feeling anxious and worried about determining which course of care is right for you. In the past, the presence of cancer cells in one or several lymph nodes always meant that a patient would receive chemotherapy to prevent the cancer from spreading. However, recent advances in breast cancer research are demonstrating that not all patients with positive lymph nodes will benefit from chemotherapy1. Therefore, you need to learn all that you can about the biology of your individual cancer before making your treatment decision.

What is Node-Positive Breast Cancer?

If a woman diagnosed with breast cancer has node-positive disease, it means that their cancer has spread from their original breast tumor to the underarm lymph nodes on the side of their breast cancer. Lymph node status is determined when your doctor removes one or several of your lymph nodes so they can be examined under a microscope for cancer cells.

Your pathology report will tell you how many lymph nodes were removed, and of those, how many tested positive for the presence of cancer cells. The more lymph nodes that contain cancer cells, the more serious the cancer might be. This information, along with your cancer size and grade, are important clinical factors in deciding what treatment to pursue after surgery. The next critical step is to determine the likelihood of your cancer returning. This key biological information, along with your age, medical history and personal priorities, can help you and your doctor decide whether not you should have chemotherapy.

Chemotherapy: Risks and Benefits

Historically, patients with node-positive breast cancer automatically received some form of chemotherapy, which uses powerful drugs to kill cancer cells that remain in the body after surgery. However, the downside of this approach is significant, since treatment with chemotherapy can lead to side effects such as hair loss, menopausal symptoms, infections, memory loss, heart problems, fertility issues, fatigue, nausea and diarrhea.

Can Node-Positive Breast Cancer Patients Avoid Chemotherapy?

If you have early-stage, estrogen receptor positive (ER+) breast cancer with positive lymph nodes, there is a test that can tell you the risk of your cancer returning, and whether or not you will benefit from chemotherapy. The Oncotype DX Breast Recurrence Score test reveals the underlying biology of your cancer by measuring the activity of certain genes in your individual tumor.

This test can help you and your doctor understand what treatment options are right for you, including whether or not you can safely forego chemotherapy. Women with high Recurrence Scores results were able to feel confident about choosing chemotherapy as a potentially life-saving option, while those with low scores were able to pursue hormonal therapy alone, sparing them the side effects of unnecessary chemotherapy.

1Albain et al. Lancet Oncol. 2010.