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Axillary management for young women with breast cancer varies between patients electing breast-conservation therapy or mastectomy

  • Audree B. TadrosEmail author
  • Tracy-Ann Moo
  • Michelle Stempel
  • Emily C. Zabor
  • Atif J. Khan
  • Monica Morrow
Epidemiology
  • 30 Downloads

Abstract

Purpose

Axillary treatment strategies for the young woman with early-stage, clinically node-negative breast cancer undergoing upfront surgery found to have 1–3 positive sentinel lymph nodes (SLNs) differ significantly after BCT and mastectomy. Here we compare axillary lymph node dissection (ALND) and regional nodal irradiation (NRI) rates between women electing breast-conservation therapy (BCT) versus mastectomy.

Methods

From 2010 to 2016, women age < 50 years with clinical T1-T2N0 breast cancer having upfront surgery and found to have a positive SLN were identified. ALND and/or NRI receipt were compared between groups.

Results

192 women undergoing BCT and 165 undergoing mastectomy were identified (median age: 44 years). 5.2% (10/192) of women undergoing BCT had an ALND versus 87% (144/165) of women undergoing mastectomy (p < 0.01). NRI was given to 48% (78/165) of mastectomy patients compared to 30% (57/192) of BCT patients (p < 0.01). Of the 75 mastectomy patients with 1–2 total positive lymph nodes after completion ALND, 44% received NRI. Women undergoing mastectomy were significantly more likely to receive both ALND and NRI than women undergoing BCS (45% vs 6%, p < 0.01).

Conclusion

Young cT1-2N0 breast cancer patients found to have 1–3 SLN metastases received ALND, NRI, and combined ALND/NRI more frequently if they elected mastectomy over BCT. Use of both ALND and postmastectomy radiotherapy (PMRT) in this population could be reduced in the future by omitting ALND in patients for whom the need for PMRT is clear with the finding of 1–2 SLN metastases.

Keywords

Breast cancer Axillary lymph node dissection Regional nodal irradiation Breast-conservation therapy Mastectomy 

Notes

Author contributions

ABT, TAM, AK, and MM were involved in the conception and design of the study. ABT and MM were involved in the acquisition of data. ABT and MM were involved in study supervision. ABT, TAM, MS, ECZ, AK, and MM were involved in the analysis and interpretation of data. All authors were involved in the writing, review, and/or revision of this manuscript and approved the final manuscript.

Funding

The preparation of this manuscript was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.

Compliance with ethical standards

Conflict of interest

First author Dr. Audree B. Tadros declares that she has no conflict of interest. Second author Dr. Tracy-Ann Moo declares that she has no conflict of interest. Third author Michelle Stempel declares that she has no conflict of interest. Fourth author Dr. Emily C. Zabor declares that she has no conflict of interest. Fifth author Dr. Atif Khan declares that he has no conflict of interest. Sixth author Dr. Monica Morrow declares the receipt of speaking honoraria from Genomic Health and Roche.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Biostatistics Service, Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkUSA

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