At the San Antonio Breast Cancer Symposium, Dr. Thomas B. Julian (Allegheny General Hospital in Pittsburgh) presented results from the NSABP B-32 trial. In that study 5,611 breast cancer patients with clinically negative axillary lymph nodes were randomized to receive sentinel lymph node (SLN) biopsy followed by axillary lymph node dissection (ALND), or SLN biopsy followed by ALND — only if the SLN biopsy was positive.
The researchers found that the size of SLN metastasis was an independent predictor of disease-free survival and overall survival on multivariate analysis, along with histologic grade, age, clinical tumor size, number of positive axillary nodes, and adjuvant therapy.
At the end of his presentation, Dr. Julian noted that a paper based on a B-32 substudy on whether isolated tumor cells and micrometastases affect patient outcomes will appear in an upcoming issue of the New England Journal of Medicine.
This happens a lot at medical meetings. Some data are presented, but some are also reserved for publication. After the presentation, a session moderator asked if it was safe to assume that because H&E-detected micrometastases did not result in worse survival than node-negative disease that the same would be true for the immuno-detected micrometastases.
Dr. Julian’s answer: “One could assume that, but you have to wait for the paper.” Again, I hear this a lot at medical meetings, and I didn’t think too much about it.
That was until a patient advocate worked up the nerve later in the session to take Dr. Julian and the research establishment to task for the way that medical research findings are typically doled out.
“I had to get up the courage to do this, but I was really offended by the last reporter, who refused to tell us the results of the study because of his need to keep it quiet for publication,” she told the audience of several thousand. “I really think this is a disservice, and it’s a symptom of what’s wrong with the research establishment. It’s something that advocates want to change … If we change the research system and not make it so dependent on careers, on money, on publications, we might be able to make more progress.”
She’s right. Presenters at big medical meetings often think in terms of data, forgetting that they’re really talking about patients. Maybe there’s no harm in waiting a couple of months to present that data, but there’s also a chance that the data could change clinical practice — that they could extend or save a life.
I’m not a physician, but I don’t think that’s a chance that I would want to take, if I were. It’s definitely not a risk I want to take as a patient.
Let us know what you think.
— Kerri Wachter (on Twitter @knwachter)