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Sentinel Node Biopsy Should Not be Routine in Older Patients with ER-Positive HER2-Negative Breast Cancer Who Are Willing and Able to Take Hormone Therapy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The SSO Choosing Wisely campaign recommended selective sentinel lymph node biopsy (SLNB) in clinically node-negative women aged ≥ 70 years with ER+ breast cancer. We sought to assess the association of SLNB positivity, adjuvant treatment, and survival in a population-based cohort.

Patients and Methods

Women aged ≥ 70 years treated for ER+ HER2− breast cancer between 2010 and 2016 were identified in our prospective provincial database. Overall survival (OS) and breast cancer-specific survival (BCSS) were assessed using Kaplan–Meier analysis. Multivariable logistic regression was used to assess the association of SLNB positivity with use of adjuvant treatments and survival outcomes.

Results

We identified 2662 patients who met study criteria. SLNB was positive in 25%. Increased use of chemotherapy (ChT), hormone therapy (HT), and radiotherapy (RT) was significantly associated with SLNB positivity. Five-year OS was 86%, and BCSS was 96% with median follow-up of 4.3 years. BCSS was worse with grade 3 disease (HR 4.1, 95% CI 2.1–8.1, p < 0.0001) and better with HT (HR 0.5 95% CI 0.3–0.9, p = 0.01). Patients with a positive SLNB treated without adjuvant therapy had lower BCSS (HR 3.2 95% CI 1.2–8.4, p = 0.017) than those with a negative SLNB, but patients with a positive SLNB treated with any combination of ChT, HT, and/or RT, had similar BCSS to those with a negative SLNB.

Conclusions

BCSS in this population was excellent at 96%, and BCSS was similar with negative and positive SLNB when patients received HT. SLNB can be omitted in elderly patients willing to take HT.

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Acknowledgment

The authors acknowledge input from the BC Cancer Breast Tumor Group and support of the BC Cancer Surgical Oncology Network for statistical analysis, and the contributions of Colleen McGahan, M.S., and Nuria Chapinal, Ph.D., as well as Crystal Ma for assistance with preparing the manuscript.

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Authors and Affiliations

  1. Providence Breast Centre, Mount Saint Joseph Hospital, Vancouver, BC, Canada

    Elaine McKevitt MEd, MD & Rebecca Warburton MD

  2. Department of Surgery, BC Cancer, Vancouver, Canada

    Elaine McKevitt MEd, MD, Rona Cheifetz MEd, MD & Rebecca Warburton MD

  3. Department of Population Oncology, BC Cancer, Vancouver, Canada

    Kimberly DeVries MSc & Lovedeep Gondara MSc

  4. Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Elaine McKevitt MEd, MD, Rona Cheifetz MEd, MD, Rebecca Warburton MD & Alan Nichol MD

  5. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Caroline Lohrisch MD

  6. Department of Surgery, University of Calgary, Alberta, Canada

    Alison Laws MD

  7. Department of Medical Oncology, BC Cancer, Vancouver, Canada

    Caroline Lohrisch MD

  8. Department of Radiation Oncology, BC Cancer, Vancouver, Canada

    Alan Nichol MD

Authors
  1. Elaine McKevitt MEd, MD
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  2. Rona Cheifetz MEd, MD
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  3. Kimberly DeVries MSc
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  4. Alison Laws MD
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  7. Caroline Lohrisch MD
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Correspondence to Elaine McKevitt MEd, MD.

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McKevitt, E., Cheifetz, R., DeVries, K. et al. Sentinel Node Biopsy Should Not be Routine in Older Patients with ER-Positive HER2-Negative Breast Cancer Who Are Willing and Able to Take Hormone Therapy. Ann Surg Oncol 28, 5950–5957 (2021). https://doi.org/10.1245/s10434-021-09839-6

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  • DOI: https://doi.org/10.1245/s10434-021-09839-6

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