A study presented at the American Society of Clinical Oncology meeting in Chicago found that radioherapy alone can match or even outdo axillary lymph node dissection (ALND) for women whose breast cancer has spread to one or two lymph nodes. The research followed 2,540 women across Sweden, Denmark, Germany,Greece and Italy, and showed that those who avoided surgery had better arm function and a slightly higher five‑year survival rate (94% vs. 93%).

One‑Fifth of Breast Cancer Patients Face the Decision to Remove Lymph Nodes

About 20% of breast cancer patients have cancer that has spread to one or two axillary lymph nodes. Historically, surgeons performed ALND to remove these nodes and prevent further spread. According to the study , ALND carries a high risk of lymphoedema, with up to half of patients developing chronic swelling that can last for years.

Radiotherapy Alone Yields Comparable Survival, Better Arm Function

The research randomized patients to either ALND plus radiation or radiation alone, then tracked arm function and survival over five years.. Results showed that the non‑surgical group reported significantly fewer lymphoedema‑related problems and better ability to lift or drive. Survival rates were similar, with a marginally higher five‑year survival for the radiation‑only group (94% vs. 93%).

Expert Voices Call for a Shift in Surgical Practice

Lead author Dr. Jana de Boniface emphasized that more axillary surgery does not improve survival and should be viewed as a diagnostic tool, not a therapeutic one. Dr. Jane Lowe Meisel noted that simplifying surgical management could have a meaningful impact on survivorship worldwide, reducing long‑term complications that affect mobility, appearance and self‑esteem.

Unanswered Question: Which Patients Truly Benefit from Skipping ALND?

While the study included a broad European cohort, it remains unclear how the findings translate to diverse populations or to patients with different tumor subtypes. the research also did not address whether certain genetic markers or imaging characteristics could predict which women would benefit most from radiation alone .

As the study was presented at ASCO, the findings are already influencing clinical discussions, but guidelines will need to incorporate these data before widespread adoption.