Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Long-term outcome of pT1a–b, cN0 breast cancer without axillary dissection or staging : a prospective observational study of 1543 women

Ingvar, C. LU ; Ahlgren, J. ; Emdin, S. ; Lofgren, L. ; Nordander, M. LU orcid ; Niméus, E. LU and Arnesson, L. G. (2020) In British Journal of Surgery 107(10). p.1299-1306
Abstract

Background: The implementation of screening programmes in Sweden during the mid-1990s increased the number of small node-negative breast cancers. In this era before staging by sentinel node biopsy, routine axillary dissection for staging of early breast cancer was questioned owing to the increased morbidity and lack of perceived benefit. The long-term risk of axillary recurrence when axillary staging is omitted remains unclear. Methods: This prospective observational multicentre cohort study included Swedish women diagnosed with breast cancer between 1997 and 2002. The patients had clinically node-negative, pT1a–b, grade I–II tumours. No axillary staging or dissection was performed. The primary outcome was ipsilateral axillary... (More)

Background: The implementation of screening programmes in Sweden during the mid-1990s increased the number of small node-negative breast cancers. In this era before staging by sentinel node biopsy, routine axillary dissection for staging of early breast cancer was questioned owing to the increased morbidity and lack of perceived benefit. The long-term risk of axillary recurrence when axillary staging is omitted remains unclear. Methods: This prospective observational multicentre cohort study included Swedish women diagnosed with breast cancer between 1997 and 2002. The patients had clinically node-negative, pT1a–b, grade I–II tumours. No axillary staging or dissection was performed. The primary outcome was ipsilateral axillary recurrence and survival. Results: A total of 1543 patients were included. Breast-conserving surgery (BCS) was performed in 94·0 per cent and the rest underwent mastectomy. After surgery, 58·1 per cent of the women received adjuvant radiotherapy, 11·9 per cent adjuvant endocrine therapy and 31·5 per cent did not receive any adjuvant treatment. After a median follow-up of 15·5 years, 6·4 per cent developed contralateral breast cancer and 16·5 per cent experienced a recurrence. The first recurrence was local in 116, regional in 47 and distant in 59 patients. The breast cancer-specific survival rate was 93·7 per cent after 15 years. There were no differences in overall or breast cancer-specific survival between patients who received adjuvant radiotherapy and those who did not. Only 3·0 per cent of patients had an axillary recurrence, which was isolated in only 1·0 per cent. Conclusion: Axillary surgery can safely be omitted in patients with low-grade, T1a–b, cN0 breast cancers. This large prospective cohort with 15-year follow-up had a very low incidence of axillary recurrences and high breast cancer-specific survival rate.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
British Journal of Surgery
volume
107
issue
10
pages
8 pages
publisher
Oxford University Press
external identifiers
  • pmid:32335901
  • scopus:85084051957
ISSN
0007-1323
DOI
10.1002/bjs.11610
project
Prognostic and treatment predictive markers for radioresistance and a low-risk profile in breast cancer
language
English
LU publication?
yes
id
dc9c9609-c65a-41f2-b4a6-6644368f8fed
date added to LUP
2020-05-28 13:36:15
date last changed
2024-04-03 08:03:00
@article{dc9c9609-c65a-41f2-b4a6-6644368f8fed,
  abstract     = {{<p>Background: The implementation of screening programmes in Sweden during the mid-1990s increased the number of small node-negative breast cancers. In this era before staging by sentinel node biopsy, routine axillary dissection for staging of early breast cancer was questioned owing to the increased morbidity and lack of perceived benefit. The long-term risk of axillary recurrence when axillary staging is omitted remains unclear. Methods: This prospective observational multicentre cohort study included Swedish women diagnosed with breast cancer between 1997 and 2002. The patients had clinically node-negative, pT1a–b, grade I–II tumours. No axillary staging or dissection was performed. The primary outcome was ipsilateral axillary recurrence and survival. Results: A total of 1543 patients were included. Breast-conserving surgery (BCS) was performed in 94·0 per cent and the rest underwent mastectomy. After surgery, 58·1 per cent of the women received adjuvant radiotherapy, 11·9 per cent adjuvant endocrine therapy and 31·5 per cent did not receive any adjuvant treatment. After a median follow-up of 15·5 years, 6·4 per cent developed contralateral breast cancer and 16·5 per cent experienced a recurrence. The first recurrence was local in 116, regional in 47 and distant in 59 patients. The breast cancer-specific survival rate was 93·7 per cent after 15 years. There were no differences in overall or breast cancer-specific survival between patients who received adjuvant radiotherapy and those who did not. Only 3·0 per cent of patients had an axillary recurrence, which was isolated in only 1·0 per cent. Conclusion: Axillary surgery can safely be omitted in patients with low-grade, T1a–b, cN0 breast cancers. This large prospective cohort with 15-year follow-up had a very low incidence of axillary recurrences and high breast cancer-specific survival rate.</p>}},
  author       = {{Ingvar, C. and Ahlgren, J. and Emdin, S. and Lofgren, L. and Nordander, M. and Niméus, E. and Arnesson, L. G.}},
  issn         = {{0007-1323}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1299--1306}},
  publisher    = {{Oxford University Press}},
  series       = {{British Journal of Surgery}},
  title        = {{Long-term outcome of pT1a–b, cN0 breast cancer without axillary dissection or staging : a prospective observational study of 1543 women}},
  url          = {{http://dx.doi.org/10.1002/bjs.11610}},
  doi          = {{10.1002/bjs.11610}},
  volume       = {{107}},
  year         = {{2020}},
}