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Identification of Populations at Risk for "Choosing Un-Wisely": A SEER Population-Based Study
Michelle J Hong1, Sharon S Lum1, Liang Ji1
1Department of Surgery, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
The American Surgeon
|June 1, 2023
Summary
Elderly women with early-stage breast cancer often receive unnecessary axillary surgery, despite guidelines recommending against it. Specific racial, ethnic, and socioeconomic groups face higher risks of overtreatment, highlighting a need for improved care de-escalation.
Area of Science:
- Oncology
- Surgical Oncology
- Health Services Research
Background:
- The Choosing Wisely campaign advises against routine axillary surgery for elderly patients with early-stage, hormone receptor-positive breast cancer since 2016.
- Despite recommendations, axillary surgery rates remain high in eligible patient populations.
Purpose of the Study:
- To evaluate factors associated with axillary surgery in elderly breast cancer patients eligible for sentinel lymph node biopsy omission.
- To identify potential disparities in axillary surgery utilization.
Main Methods:
- Analysis of the Surveillance, Epidemiology, and End Results (SEER) database for female patients aged ≥70 years with specific early-stage breast cancer characteristics (2016-2019).
- Multivariable analysis of patient demographics, tumor characteristics, and treatment modalities linked to axillary surgery.
Main Results:
- 81.2% of 31,756 eligible patients underwent axillary surgery.
- Hispanic ethnicity, lower-middle income, rural treatment, advanced tumor characteristics, and receipt of radiation/systemic therapy were associated with axillary surgery.
- A small percentage (2.1%) of patients undergoing axillary surgery had positive lymph nodes.
Conclusions:
- Certain racial, ethnic, socioeconomic, and geographic groups of elderly patients are at higher risk for overtreatment with axillary surgery.
- Findings indicate opportunities for targeted education and de-escalation of unnecessary procedures to reduce overtreatment.
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