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Patterns of axillary evaluation in older patients with breast cancer and associations with adjuvant therapy receipt

  • Epidemiology
  • Published:
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Abstract

Purpose

Although axillary lymph node status has traditionally been a key factor in informing adjuvant breast cancer therapy recommendations, this information may be less relevant as our focus shifts more towards tumor biology, particularly in older patients where comorbidity influences treatment decisions and nodal staging and/or surgery may not improve outcomes. We examined patterns of axillary surgery and associations between axillary surgery and receipt of adjuvant treatment in older breast cancer patients.

Methods

Women aged ≥ 65 years with clinically node-negative, stage I–II breast cancer treated between 2012 and 2013 were identified using the National Cancer Data Base. Using multivariable logistic regression, we examined associations between axillary surgery and age, adjusting for patient, clinical, and facility factors. We also examined receipt of adjuvant treatment by nodal surgery.

Results

Among 68,205 women, 40.1% were aged 65–70, 24.5% were 71–75, 17.4% were 76–80, and 18.0% were > 80. Overall, 91.2% had axillary surgery (67.8% sentinel lymph node biopsy, 11.7% axillary lymph node dissection, 11.7% unspecified/unknown axillary surgery); 88.0% of those aged ≥ 70 with lower risk, hormone receptor-positive tumors underwent axillary surgery. In adjusted analyses, compared to patients aged 65–70, increasing age was associated with lower odds of any axillary surgery (ages 71–75: OR 0.64, 95% CI 0.57–0.71; ages 76–80: OR 0.33, 95% CI 0.30–0.37; age > 80: OR 0.08, 95% CI 0.07–0.08). Axillary surgery was associated with higher odds of receipt of radiation after breast conservation and receipt of chemotherapy in human epidermal growth factor 2-positive disease.

Conclusions

In a large nationwide dataset, the vast majority of older women with clinically node-negative breast cancer underwent axillary staging despite uncertainty about its impact on survival, particularly for those with lower-risk disease. Further study on how to tailor node assessment in older patients is warranted.

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Acknowledgements

The data used in the study are derived from a limited dataset of the National Cancer Data Base (NCDB). The authors acknowledge the efforts of the American College of Surgeons, the Commission on Cancer, and the American Cancer Society in the creation of the National Cancer Data Base. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the authors.

Funding

This study was supported by the following: Dr. Freedman is supported by the American Cancer Society (125912-MRSG-14-240-01-CPPB) and Susan G. Komen (CCR CCR14298143).

Author information

Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, 450 Brookline Ave, Yawkey 14, Boston, MA, 02215, USA

    Laura S. Dominici & Tari A. King

  2. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA

    Helmneh M. Sineshaw, Ahmedin Jemal & Chun Chieh Lin

  3. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Rachel A. Freedman

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  1. Laura S. Dominici
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Correspondence to Laura S. Dominici.

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Conflict of interest

Dr. Freedman receives institutional funding only from Genentech, Eisai, and Puma Biotechnology. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Dominici, L.S., Sineshaw, H.M., Jemal, A. et al. Patterns of axillary evaluation in older patients with breast cancer and associations with adjuvant therapy receipt. Breast Cancer Res Treat 167, 555–566 (2018). https://doi.org/10.1007/s10549-017-4528-6

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  • DOI: https://doi.org/10.1007/s10549-017-4528-6

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