ASO Author Reflections: Put the Scalpel Down—Axillary Surgery is not Indicated for Patients ≥ 70 Years Undergoing Mastectomy for DCIS

Axillary management in breast cancer treatment has become increasingly complex as studies have continually demonstrated the safety of sparing patients the morbidity of lymphadenectomy. No longer is axillary dissection recommended for every patient with breast cancer; contemporary breast surgical decisions are based upon patient factors, tumor biology, neoadjuvant and adjuvant therapies, and their sequence. Adoption of trial findings from NSABP-B32¹ led to widespread use of sentinel node biopsy, ACOSOG Z0011² and AMAROS³ proved that completion axillary dissection conferred no measurable benefit for low-risk patients, and extrapolation of the results from CALGB 9343⁴ opened the door to omitting axillary surgery altogether. With the goal of de-escalating low-value care, the Society of Surgical Oncology joined forces with the Choosing Wisely Campaign in 2016 to recommend omission of sentinel lymphadenectomy (SLNB) for patients who are unlikely to benefit from the procedure, specifically women aged 70 years or older with early-stage HR+/HER2− breast cancer. The breast surgery community continues to seek evidence-based methods for de-escalation of the axilla in other clinical situations for patients in whom axillary surgery may not be beneficial. …