New Analysis Evaluates Predictors of Persistent Pain After Breast Cancer Surgery

Key Points

  • Disruption of sensory nerves in the axilla as lymph nodes are removed is associated with an up to 21% increase in the risk of development of chronic pain.
  • Current standards in axillary surgery have already undergone a significant shift towards sentinel node biopsy, which lessens all potential complications for many patients, said researchers.

An analysis led by McMaster University researchers has found that women who undergo armpit lymph node surgery for breast cancer are much more likely to develop chronic pain. Wang et al published their review of studies exploring risk factors for developing chronic pain after breast cancer surgery—which also included younger age and radiation therapy—in the Canadian Medical Association Journal.

“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, DC, PhD. He is an Assistant Professor of anesthesia and a researcher with the Michael G. DeGroote Institute for Pain Research and Care at the Michael G. DeGroote School of Medicine.

The international research team, led by Dr. Busse's postdoctoral student, Li Wang, PhD, conducted a systematic review that analyzed 30 observational studies that enrolled 20,000 women undergoing surgery for breast cancer. Analysis of this 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,” Dr. Busse added. “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 Susan Reid, MD, an author on the study. She is also Professor and Chair of Surgery at McMaster's Michael G. DeGroote School of Medicine and a breast cancer surgeon.

“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.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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