ASO Author Reflections: Overtreatment of Older Females with Favorable-Prognosis Breast Cancer

Abstract

Prior to the release of the Society of Surgical Oncology’s Choosing Wisely guidelines, women diagnosed with early stage breast cancer in their later decades of life historically underwent the same aggressive therapies as their younger counterparts. The treatment algorithm routinely included surgical staging of the axilla and adjuvant radiation therapy. There has been concern that older females are subject to discordant provider judgement as a result of underrepresentation in clinical trials. The Choosing Wisely recommendation to omit sentinel lymph node biopsy in women over the age of seventy with early stage, clinically node-negative, hormone-positive, HER2-negative invasive breast cancer was based on the results of multiple prospective randomized trials demonstrating that survival in this target population is independent of nodal tumor burden.