AI analysis suggest breast cancer surgery “may do more harm than good” for middle-aged patients

Editor's Note

Artificial intelligence (AI)-fueled analysis of electronic health records suggests that clinical guidelines for de-escalating surgery should be extended to younger breast cancer patients.

Conducted by University of Pittsburgh and UPMC Hillman Cancer Center researchers and published in JCO Clinical Cancer Informatics, the analysis suggests that “surgery involving sentinel lymph node biopsy for middle-aged women with estrogen receptor-positive (ER+) breast cancer may do more harm than good,” Medical Xpress reported on May 23. “The findings… suggest that clinical guidelines for de-escalating surgery in women aged over 70 years with early-stage ER+ breast cancer may be safely extended to post-menopausal patients 55 or older.”

Sentinel lymph node biopsy is standard procedure for detecting cancer’s spread, but the surgery carries a small risk of lymphedema (the uncomfortable buildup of lymphatic fluid), researchers point out. The findings suggest a more individualized approach can be preferable to exposing all patients to this risk.

Recommendations to avoid the procedure in women over 70 diagnosed with early-stage ER+ breast cancer—a population with low risk of metastasis—date to the 2016 release of the Society of Surgical Oncology’s “Choosing Wisely” initiative, MedicalXpress reports.

The AI tool researchers used to explore whether that guideline could be extended to younger patients is described in the report as an “artificial intelligence pipeline developed by Realyze Intelligence, a UPMC Enterprises portfolio company.” Analyzing records of  925 patients aged 55 or older who were diagnosed with ER+ breast cancer between 2015 and 2017 and had undergone sentinel lymph node biopsy, the tool enabled comparing rates of cancer spread with rates of lymphedema across a 5-year follow-up period.

"The power of Realyze is that it goes into these notes and pulls out information by looking at the language itself and, importantly, the context of that language,” one researcher wrote. “So, it allowed us to look not only for records of lymphedema but also where that lymphedema was located. That's important because arm and breast lymphedema are likely to be related to lymph node biopsy, whereas leg lymphedema is likely due to other conditions."