De-Escalation of Breast Surgery: Less Is More

Patients with early-stage breast cancer who have ER-positive tumors and clinically node-negative axilla can forego sentinel lymph node biopsy without negative consequence.

Surgical management of early-stage breast cancer has evolved over the last two decades towards de-escalation. Surgeries have become less extensive and the question of whether any surgical intervention is needed for the axilla remains open for debate.

In the prospective, noninferiority INSEMA trial, women with clinical stage T1 or T2 tumors, clinical axillary node–negative disease (both by exam and imaging with ultrasound), and a plan for breast-conserving surgery were randomized (1:4) to treatment without axillary surgery or to sentinel lymph node biopsy (SLNB). Patients undergoing SLNB found to have 1 to 3 macrometastases were further randomized to completion axillary dissection or no further axillary surgery (data not mature).

Among the per…

Reviewing Author

William J. Gradishar, MD

Disclosures

Consultant/Advisory BoardLilly; AstraZeneca; Gilead

Grant/Research SupportBreast Cancer Research Foundation

Editorial BoardsClinical Breast Cancer; Oncology; Annals of Surgery; Breast Cancer Research and Treatment

Leadership Positions in Professional SocietiesNational Comprehensive Cancer Network (Chair, Breast Cancer Panel); American Board of Internal Medicine (Medical Oncology Board)