TY  - JOUR
T1  - UNnecessary axillary surgery for patients with node-negative breast cancer undergoing total mastectomy
AU  - Olaya W, Morgan JW, Lum SS
Y1  - 2011/09/01
N1  - 10.1001/archsurg.2011.196
JO  - Archives of Surgery
SP  - 1029
EP  - 1033
VL  - 146
IS  - 9
N2  - Objective 
                  To identify factors associated with the use of axillary lymph node dissection (ALND) as the initial axillary staging in node-negative breast cancer patients undergoing total mastectomy.Design 
                  California Cancer Registry study.Setting 
                  Academic research.Patients 
                  Women treated with total mastectomy for Tis, T1, or T2 node-negative breast carcinoma treated between January 1, 2004, and December 31, 2008.Main Outcome Measures 
                  Proportions of patients who underwent ALND without prior sentinel lymph node dissection were compared by demographic characteristics.Results 
                  Of 18 238 women treated with total mastectomy for Tis, T1, or T2 node-negative breast carcinoma, 35.1% underwent initial axillary staging by ALND without prior sentinel lymph node dissection. On multivariable analyses, patients were significantly more likely to undergo ALND if they had T2 disease or were 65 years or older, were hormone receptor negative, of Hispanic or Asian/Pacific Islander race/ethnicity, of lower socioeconomic quintile, operated on during earlier years of the study period, and not treated by a hospital cancer program approved by the American College of Surgeons.Conclusions 
                  More than one-third of patients in California who underwent total mastectomy for treatment of early-stage node-negative breast carcinoma received ALND without prior sentinel lymph node dissection; furthermore, certain subsets of patients have higher odds of undergoing ALND alone. To avoid the unnecessary morbidity of ALND in early-stage breast carcinoma, further research is required to elucidate how tumor, patient, and system factors can be modified to improve delivery of optimal breast cancer care.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2011.196
UR  - http://dx.doi.org/10.1001/archsurg.2011.196
ER  -