Abstract
Objective
To identify factors associated with under-use of sentinel lymph node dissection (SLND).
Materials and Methods
This study was performed in ELIPPSE 65, a representative cohort of women aged ≥65 with breast cancer. We included all women eligible for SLND. Characteristics of
those who had received SLND – whether or not axillary lymph node dissection (ALND)
was subsequently carried out – were compared with those having received immediate
ALND without prior SLND.
Results
A total of 349 women were eligible for SLND. After excluding those without surgery
or with unknown axillary surgery type, 337 women were analyzed. Immediate ALND was
performed in 20% of cases. Immediate ALND had been performed more frequently in women
aged ≥75 and in those who had poor family support.
Conclusion
Although SLND is a widespread surgical practice, many women still have unnecessary
ALND. This is particularly detrimental for elderly women as their life may be strongly
impaired by lymphedema.
Keywords
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References
- A multicenter cohort study to compare quality of life in breast cancer patients according to sentinel lymph node biopsy or axillary lymph node dissection.Ann Oncol. 2009; 20: 1352-1361
- Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group.Breast. 2008; 17: 138-147
- Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial.J Natl Cancer Inst. 2006; 98: 599-609
- Comparable survival between pN0 breast cancer patients undergoing sentinel node biopsy and extensive axillary dissection: a report from the Korean Breast Cancer Society.J Clin Oncol. 2010; 28: 1692-1699
- Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study.Ann Surg. 2010; 251: 595-600
- American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.J Clin Oncol. 2005; 23: 7703-7720
- Disparities and trends in sentinel lymph node biopsy among early-stage breast cancer patients (1998–2005).J Natl Cancer Inst. 2008; 100: 462-474
- Beyond the clinical trials: how often is sentinel lymph node dissection performed for breast cancer?.Ann Surg Oncol. 2005; 12: 41-47
- Factors associated with variance in compliance with a sentinel lymph node dissection quality measure in early-stage breast cancer.Ann Surg Oncol. 2010; 17: 297-302
- Race and age disparities in receipt of sentinel lymph node biopsy for early-stage breast cancer.Breast Cancer Res Treat. 2011; 128: 863-871
- Patterns of axillary surgical care for breast cancer in the era of sentinel lymph node biopsy.Ann Surg Oncol. 2009; 16: 687-696
- Computer assisted telephone interviewing: effects on interviewers and respondents.Public Opin Q. 1984; 48: 356-369
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Prise en charge du Cancer du Sein non métastatique.
- Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.J Am Geriatr Soc. 1983; 31: 721-727
- The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire.J Gerontol. 1981; 36: 428-434
- The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly.Int J Geriatr Psychiatry. 2000; 15: 1021-1027
- Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV.Int J Geriatr Psychiatry. 1999; 14: 858-865
- Weight, shape, and mortality risk in older persons: elevated waist–hip ratio, not high body mass index, is associated with a greater risk of death.Am J Clin Nutr. 2006; 84: 449-460
- The WHOQOL-BREF questionnaire: French adult population norms for the physical health, psychological health and social relationship dimensions.Rev Epidemiol Sante Publique. 2010; 58: 33-39
- The surgical management of elderly cancer patients; recommendations of the SIOG surgical task force.Eur J Cancer. 2004; 40: 926-938
- Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology.Lancet Oncol. 2007; 8: 1101-1115
- Sentinel node biopsy in elderly breast cancer patients.Surg Oncol. 2004; 13: 193-196
- A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up.Ann Surg. 2005; 242 (discussion 7–9): 1-6
- Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10–93.J Clin Oncol. 2006; 24: 337-344
- Selective application of axillary node dissection in elderly women with early breast cancer.Ann Surg Oncol. 2007; 14: 652-659
- Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis.Cancer. 2006; 106: 4-16
- Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial.JAMA. 2011; 305: 569-575
- Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database.Ann Surg Oncol. 2010; 17: 343-351
- Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer.J Clin Oncol. 2009; 27: 2946-2953
- A declining rate of completion axillary dissection in sentinel lymph node-positive breast cancer patients is associated with the use of a multivariate nomogram.Ann Surg. 2007; 245: 462-468
- Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival.J Clin Oncol. 2010; 28: 2038-2045
- Relationship between age and axillary lymph node involvement in women with breast cancer.J Clin Oncol. 2009; 27: 2931-2937
- Age-related variations in the use of axillary staging may explain the increased risk of axillary lymph node involvement in older women with breast cancer.J Clin Oncol. 2009; 27 (author reply e8): e276-e277
- Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients ‘on behalf of the Group of Surgeons from the French Unicancer Federation’.Ann Oncol. 2011; ([Electronic publication ahead of print])
- Determinants of cancer therapy in elderly patients.Cancer. 1993; 72: 594-601
- Older female cancer patients: importance, causes, and consequences of undertreatment.J Clin Oncol. 2007; 25: 1858-1869
- Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study.Ann Oncol. 2010; 21: 748-753
- Dealing with metastatic breast cancer in elderly women: results from a French study on a large cohort carried out by the ‘Observatory on Elderly Patients’.Ann Oncol. 2006; 17: 211-216
- The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group.Cancer Epidemiol Biomarkers Prev. 1994; 3: 253-259
- Effect of nurse case management on the treatment of older women with breast cancer.J Am Geriatr Soc. 2003; 51: 1252-1259
- EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary.Eur J Cancer. 2009; 45: 931-991
- Lymphedema following axillary lymph node dissection for breast cancer.Surg Oncol. 2006; 15: 153-165
- Lymphoedema and reduced shoulder function as indicators of quality of life after axillary lymph node dissection for invasive breast cancer.Br J Surg. 2003; 90: 76-81
- Critical assessment of the clinical TNM system in breast cancer. Report from the Yorkshire Breast Cancer Group.Br Med J. 1980; 281: 134-136
Biography
Dr. Camille Cluze is a doctor graduated in Medicine and specialized in Public Health at the University of Lyon in 2009. She obtained a Masters in Biostatistics in 2008. Her research interests include the epidemiology and management of cancer, specifically breast cancer.
Article info
Publication history
Published online: March 16, 2012
Accepted:
February 15,
2012
Received in revised form:
January 12,
2012
Received:
November 28,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
