A pilot study to examine the experiences and attitudes of women with breast cancer towards one versus two-step axillary surgery
Sentinel lymph node (SNB) biopsy is now established as an accurate, minimally invasive means of providing regional staging for primary breast cancer. However, 25% of patients who have the SNB biopsy require further axillary surgery or radiotherapy to the axilla because of spread of disease. More recently, an intra-operative SNB analysis has been adopted that allows immediate progression to axillary clearance in patients with node positive breast cancer and reduces the need for re-operation. It is a reliable and sensitive method for the detection of sentinel lymph node metastasis (Leung, Chan et al. 2007). Although there are concerns over the potential for false negative results with the intra operative SNB analysis, it has some clear potential advantages. However, the OSNA investigation is not accepted practice in the vast majority of breast units around the UK and other countries, is not NICE approved and is not in the Sussex Cancer Network guidelines for breast cancer. However, for the past 2 years at Guildford Hospital, Surrey, all clinically node negative NHS patients undergo intra-operative SNB analysis. Approximately 250 women have received this procedure and anecdotally there have been few problems but no scientific data have, as yet, been collected. In Brighton, the OSNA procedure is yet to be adopted and patients with positive SNB have further axillary dissection or clearance.
This pilot study aims to examine and compare the views of two cohorts of women from both Brighton and Guildford: those who have and those who have not had the procedure but have undergone axillary surgery to gather data to inform a prospective communication and patient preference study.