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Modern surgery and systemic therapies to treat breast cancer have become so effective that post-surgery radiation is medically unnecessary for most women, according to research findings by a M.D. Anderson doctor who lives in West University Place.

Leading the research study was Dr. Henry Kuerer, professor and Training Program Director in M. D. Anderson’s Department of Surgical Oncology, who lives in the 5800 block of Charlotte Street. Kuerer and his associates found that breast cancer patients with early stage disease that has spread to only one lymph node may not benefit from radiation after mastectomy, because of the low present-day risk of recurrence following modern surgery and systemic therapy.

Dr. Henry Kuerer

The finding could one day change the course of treatment for thousands of women diagnosed each year. An estimated 47,000 women are diagnosed annually with breast cancer involving one to three lymph nodes. Of those, 30,000 have only one lymph node involvement.

Research studies in the 1990s and in 2005 came to the conclusion that radiation therapy after surgical treatment did have an effect on survival and the recurrence of the breast cancer. These study findings shifted clinical practice because the National Comprehensive Cancer Network altered their medical guidelines in 2007 to suggest that stage I and II breast cancer patients with one to three lymph node metastases “strongly consider” radiation post-mastectomy.

“The need for post-mastectomy radiation in early stage breast cancer patients has been a topic of great debate within the cancer community for decades,” Kuerer said in a statement. “We have entered a new era of breast cancer diagnosis and treatment. Modern day advances in all modalities have been dramatic and, collaboratively, have had a significant impact on recurrence and survival.”

Kuerer and his colleagues studied clinical and pathological factors from 1,022 stage I or II breast cancer patients who received a mastectomy at M. D. Anderson between 1997 and 2002. Of those women, 79 percent had no lymph node involvement, 26 percent had one to three positive lymph nodes, with the majority having just one positive node. None received post-mastectomy radiation and/or pre-operative chemotherapy; 77 percent received post-operative chemotherapy and/or hormonal therapy. The median age was 54 years and the median follow-up time was 7.5 years.

The researchers found there was no statistical difference in the 10-year risk of recurrence in women without lymph node spread versus those with spread to one node – 2.1 percent to 3.3 percent, respectively.

The only independent risk factor for recurrence was age: patients age 40 and younger, regardless of node involvement, were at significant increased risk for their cancer coming back.

“For these younger women, not less, but more treatment may be needed,” said Rajna Sharma, M.D., a fellow in M. D. Anderson’s Department of Surgical Oncology, who presented the findings.

But for the overwhelming majority, the risk of recurrence was too low to justify routine use of post-surgery radiation therapy.

“This research will provoke much discussion among those caring for women with early-stage breast disease,” Kuerer said. “Replicating these findings should be a priority to ensure that patients only receive therapy that is medically necessary.”