Talk is cheap.
Large phase 3 trial data consistently fails to demonstrate a survival advantage when surgical axillary staging is added for cT1N0 ER+ HER2- breast cancer in older women. Nonetheless, more than 80% of women over 70 years of age with above-described low-risk disease continue to receive sentinel node biopsies (SLNB). This qualitative study with interviews across oncologic specialities aimed to understand why, and table 2 lays out some pretty solid reasoning behind the decisions to proceed with a SLNB. The summary is that not all 70 years olds are created equal, and neither are all cT1N0 ER+ HER2- tumors (e.g., what about extensive LVI or ER-low tumors?). Perhaps the most interesting recurring theme was surgeons’ fear that omission of SLNB would negatively impact the decision-making of medical and radiation oncology colleagues who would then tell the patient she should have had a SLNB. What does NCCN say? Basically to omit SLNB when it won’t change adjuvant therapy decisions. And therein lies the biggest avenue for de-escalating care: a pre-op conversation amongst oncology colleagues about whether SLNB omission will affect confidence in adjuvant therapy decisions. | Minami, JAMA Netw Open 2022