, Volume 15, Issue 10, pp 2978-2979
Date: 26 Feb 2008

Benefits and Harms in Avoiding Axilla Lymphadenectomy in Breast Cancer

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To the Editor,

Recently, there has been a trend toward less extensive surgery for improving quality of life in the multimodality treatment of breast cancer. Based on randomized evidence for the safety and efficacy of breast-conserving surgery (BCS) and sentinel nodal biopsy (SNB), as well as the efficacy of empirical cytotoxic and targeted (anti-HER2, anti-ER) agents, minimal surgery in the treatment of early-stage breast cancer has become more common.1 However, results of 10-year survival studies and beyond have demonstrated a local recurrence risk after BCS ranging from 10% to 20%, suggesting that candidate patients for BCS should be carefully selected.2,3 Recently, a landmark meta-analysis study demonstrated that one of four patients who develops local recurrence die of the disease, and overall survival can be significantly reduced by inadequate local control.4 With the wider clinical use of SNB and a trend toward sparing axilla lymphadenectomy (ALD) even by positive SNB, would harms ...