Necessity of axillary dissection in elderly women with early breast cancer

The need for axillary dissection for staging and treating early breast cancer has been questioned recently. Can a patient forego axillary dissection, with its associated costs, risks, and morbidity, if it does not affect survival? The study attempted to find a subset of patients with early breast cancer in whom disease-free survival was independent of axillary lymph node status. If survival does not depend on lymph node status, axillary dissection could be omitted in the care of these patients. This study included 378 women over age 70 with T1 breast cancer diagnosed and treated during January 1992 to December 1999 at both of our institutions: a large tertiary teaching hospital in Columbus, Ohio and a breast cancer treatment center in West Columbia, South Carolina. We compared the disease-free survival, using the Kaplan-Meier estimate, in 334 node-negative patients and 44 node-positive patients with T1 breast cancer. The 3- and 5-year survival rates of patients with T1N0 tumors were 86% and 77%, respectively; and the 3- and 5-year survival rates for T1 node-positive tumors were 81% and 69%, respectively (p = 0.0673). There was no statistical difference between the node-negative and node-positive groups. Axillary dissection in women over 70 years of age with early breast cancer may be unnecessary, as the presence of lymph node metastases does not appear to affect disease-free survival rates significantly in this patient group.