"Less Is More"
A Mission to Prove Less Is More
After decades knocking down pillars of conventional thinking, Armando E. Giuliano, MD, could not have been more pleased with the 2011 New York Times article about his game-changing research. A framed copy of the article is displayed in his office. Its headline reads: “Lymph Node Study Shakes Pillar of Breast Cancer Care.”
“It’s very dramatic,” he says with a glint of hard-earned satisfaction in his eyes.
So is the arc of his career as a surgeon, scientist, and educator dedicated to increasing survival rates while improving patient quality of life. Dr. Giuliano has been at the forefront of historic changes in breast cancer treatment for more than three decades. Yet he has sometimes felt like a voice in the wilderness, challenging the prevailing idea in breast cancer surgery that “more had to be better.”
Dr. Giuliano was among the researchers who participated in a landmark 1980 study that showed a breast-sparing lumpectomy could be as effective as a mastectomy for some patients. He has pursued scientific proof that “less is more” in breast cancer surgery ever since. He is also focused on identifying target genes to more effectively fight the most aggressive and difficult-to-treat breast cancers.
With high-voltage energy contained in a lean frame with an aura of quiet intensity, Dr. Giuliano addresses questions with the efficiency of someone perpetually on call. “As we did more and more mammograms and found earlier tumors that are less likely to spread to the lymph nodes,” he explains, “it became clear that removing one sentinel node could be as effective as removing 30 lymph nodes.”
Based on a collaborative, nationwide clinical trial led by Dr. Giuliano through the American College of Surgeons Oncology Group, this finding challenged the commonly held belief that removing all lymph nodes was the key to improving breast cancer survival rates. The February 9, 2011, New York Times article noted: “The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping cancer from spreading or coming back.”
Dr. Giuliano found further evidence to support his minimally invasive approach with his next discovery, published just five months later. The study found that removing lymph nodes because of microscopic cancer cells in the sentinel lymph node did not impact survival outcomes for women with early-stage breast cancer. This means potential freedom from the side effects of lymph node removal—such as arm swelling, pain, and loss of mobility.
Mary Ann Mobley, actor, singer, and former Miss America, is among Dr. Giuliano’s many longtime patients. She calls him “committed, sensitive, and brilliant.” As she says: “He is incredibly caring. He is a true partner—you never feel alone.”