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

Tadros, Audree B; Moo, Tracy-Ann; Stempel, Michelle; Zabor, Emily C.; Khan, Atif J.; Morrow, Monica

doi:10.1007/s10549-019-05520-5

Cited by 15 publications

(5 citation statements)

References 32 publications

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“… 14 , 15 It seems that surgeons are more reserved in omitting ALND in young patients with an aggressive tumor subtype, albeit that a recent study suggests that clinicians may forego ALND in young patients when PMRT will be administered. 20 Furthermore, the results of our study showed that patients who undergo adjuvant chemotherapy also were more likely to receive ALND. The higher likelihood of macrometastatic disease or high-grade disease in patients undergoing adjuvant chemotherapy probably contributes to this correlation, albeit that hospital type and the innovative characteric within a hospital also influences the use of systemic therapies and axillary treatment.…”

Section: Discussionmentioning

confidence: 55%

Trends of Axillary Treatment in Sentinel Node-Positive Breast Cancer Patients Undergoing Mastectomy

et al. 2023

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Background The ACOSOG-Z0011- and the AMAROS-trial obviated the need for axillary surgery in most sentinel node-positive (SLN+) breast cancer patients undergoing breast-conserving surgery (BCS). Data for patients who undergo mastectomy is scarce. The purpose of this study was to investigate patterns of axillary treatment in SLN+ patients treated by mastectomy in the years after the publication of landmark studies regarding axillary treatment in SLN+ breast cancer patients undergoing BCS. Methods This was a population-based study in cT1-3N0M0 breast cancer patients treated by mastectomy and staged as SLN+ between 2009 and 2018. The performance of an axillary lymph node dissection (ALND) and/or administration of postmastectomy radiotherapy (PMRT) were primary outcomes and were studied over time. Results The study included 10,633 patients. The frequency of ALND performance decreased from 78% in 2009 to 10% in 2018, whereas PMRT increased from 4 to 49% (P < 0.001). In ≥N1a patients, ALND performance decreased from 93 to 20%, whereas PMRT increased to 70% (P < 0.001). In N1mi and N0itc patients, ALND was abandoned during the study period, whereas PMRT increased to 38% and 13% respectively (P < 0.001), respectively. Age, tumor subtype, N-stage, and hospital type affected the likelihood that patients underwent ALND. Conclusions In this study in SLN+ breast cancer patients undergoing mastectomy, use of ALND decreased drastically over time. By the end of 2018 most ≥N1a patients received PMRT as the only adjuvant axillary treatment, whereas the majority of N1mi and N0itc patients received no additional treatment.

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Section: Discussionmentioning

confidence: 55%

Trends of Axillary Treatment in Sentinel Node-Positive Breast Cancer Patients Undergoing Mastectomy

et al. 2023

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“…Colpaert and colleagues found that the primary tumor was an independent prognostic factor while axillary micrometastasis were not, and they proposed that micrometastatic disease somehow primes the immune system, allowing for a more robust response against further tumor invasion. The 5-year overall survival in the study by 7,9 Langer and colleagues was equal in bothgroups.…”

Section: Table 5: Showing Surgical Treatment Options In Ebc Patientsmentioning

confidence: 81%

“Level Three Nodal Involvement in Patients With Early Breast Cancer –A Cross Sectional Study From a Tertiary Care Institution in Kerala”

George,

Siyad A K

2024

PIJR

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Background Breast cancer is the most common cancer among humans. The mainstay of breast cancer treatment includes surgery followed by chemotherapy radiotherapy and targeted therapy. Aggressive axillary surgery increase morbidity and reduce the quality of life in terms of lymphedema which affects 20% of those who undergo axillary dissection2.The most important predictor for decreased survival and recurrence in patients with early breast cancer is the presence of axillary lymph node metastases. Axillary nodal involvement in breast cancer is unpredictable but once involved it starts from level 1and follow systematic order from level 1 to 2 to 3. Objectives 1. To find the proportion of patients who turn out to have positive level three axillary nodal metastasis following axillary dissection for early breast cancer 2. To find out factors associated with level 3 node involvement in early breast cancer. Methods Data was collected from 77 patients with early breast cancer. Axillary level 3 nodes were labelled separately during breast surgery and send to pathology for HPE and ER PR and her2neu status and results recorded. Results And Discussion Out of the 77 patients studied 3 of them turned out positive for level 3 nodal disease, even though 40 percent of patients were having clinically palpable nodes in the axilla. ConclusionAmong 77 patients with early Breast cancer 3 (4 percent) were having level 3 nodal disease and the rest of them, 74 (96 percent) were free of level 3 nodal disease. Hence avoiding aggressive axillary dissection and limiting to levels 1 and 2 in EBC will be beneficial in preventing morbidity and for better quality of life.

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“…Use of the completion axillary lymph node dissection (ALND) was significantly higher in patients who underwent a mastectomy (144/165, 87%), than in patients who underwent BCS (10/192, 5.2%). Regional nodal irradiation was given to a greater proportion of patients who underwent a mastectomy than BCS (48% vs. 30%, p < 0.01) [ 57 ]. This reflects the adoption of the ACOSOG Z0011 findings into the AYA population and follows a similar trend to the general population with breast cancer [ 81 ].…”

Section: Resultsmentioning

confidence: 99%

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

2022

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Adolescents and young women (AYA) with breast cancer represent a unique patient population, compared to the general population with breast cancer. We performed a literature review to evaluate the factors that influenced the surgical outcomes in this patient population. Fifty-two studies were identified, which evaluated breast surgery type, axillary surgery, contralateral prophylactic mastectomy (CPM), surgical timing, psychological factors, disparities, and imaging use. AYA patients had equivalent oncologic outcomes with breast conserving surgery (BCS) or mastectomy. CPM did not improve survival. There are limited data on axillary management in the AYA population, and while more data would be beneficial, this is currently extrapolated from the general breast cancer population. A shorter time to initiate treatment correlated to better outcomes, and disparities need to be overcome for optimal outcomes. AYA patients appreciated involvement in clinical decisions, and shared decision making should be considered whenever possible. Providers must keep these factors in mind when counseling AYA patients, regarding the surgical management of breast cancer.

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

Cited by 15 publications

References 32 publications

Trends of Axillary Treatment in Sentinel Node-Positive Breast Cancer Patients Undergoing Mastectomy

Trends of Axillary Treatment in Sentinel Node-Positive Breast Cancer Patients Undergoing Mastectomy

“Level Three Nodal Involvement in Patients With Early Breast Cancer –A Cross Sectional Study From a Tertiary Care Institution in Kerala”

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

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