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10.1245/s10434-006-9092-y
Annals of Surgical Oncology 14:652-659 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Selective Application of Axillary Node Dissection in Elderly Women with Early Breast Cancer

Dalal Aziz, MD1, Sandra Gardner, MMath2, Kathleen Pritchard, MD2,3,4, Lawrence Paszat, MD, MPH4,5,6 and Claire M. B. Holloway, MD, PhD1,7

1 Department of Surgery, University of Toronto, 100 College Street, Toronto, Canada M5G 1L5
2 Department of Clinical Trials and Epidemiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto Canada M4N 3M5
3 Department of Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Canada M4N 3M5
4 Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, Canada M5G 2C4
5 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Canada M4N 3M5
6 Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Toronto, Canada M4N 3M5
7 Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Canada M4N 3M5

Correspondence: Address correspondence and reprint requests to: Claire M. B. Holloway, MD, PhD; E-mail: claire.holloway{at}sunnybrook.ca

Background: Routine use of axillary lymph node dissection (ALND) has been questioned in elderly women. This study examines whether selective application of ALND in early stage breast cancer affects breast cancer-related survival.

Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, records of women ≥70 years of age with stage I or II breast cancer diagnosed between 1990 and 1995 were reviewed. Hazard ratios (HR) of cause-specific survival (CSS) between women receiving ALND and those who did not were compared. To minimize the potential for bias in the selection of women to receive ALND, HR of CSS was compared within propensity analysis deciles.

Results: 20,151 women entered the analysis. Median follow up was 6 years (interquartile range 4.33–7.67 years). Seventy-five percent underwent ALND. Women with higher risk disease and younger age were more likely to undergo ALND. Five year unadjusted CSS in women who did and did not receive ALND was 92.1% and 90.6%, respectively, with a HR of 0.85, P = 0.002. Using the propensity analysis method, the adjusted HR for CSS associated with ALND was 0.89, P = 0.066.

Discussion: After adjusting for differences in the probability of receiving ALND, no clinically or statistically significant difference in survival was observed among women who received ALND when compared with those who did not, although we could not account for differences in co-morbidity or use of systemic therapy between groups.

Conclusion: Surgeons select elderly women with early stage breast cancer for ALND with a negligible impact on CSS.

Key Words: Axillary lymph node dissection • SEER database • Breast cancer • Age • Survival






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