title: Axillary dissection versus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up.
abstract: OBJECTIVE
  To assess the long-term safety of no axillary clearance in elderly patients with breast cancer and nonpalpable axillary nodes.
  
  
  BACKGROUND
  Lymph node evaluation in elderly patients with early breast cancer and clinically negative axillary nodes is controversial. Our randomized trial with 5-year follow-up showed no breast cancer mortality advantage for axillary clearance compared with observation in older patients with T1N0 disease.
  
  
  METHODS
  We further investigated axillary treatment in a retrospective analysis of 671 consecutive patients, aged ≥ 70 years, with operable breast cancer and a clinically clear axilla, treated between 1987 and 1992; 172 received and 499 did not receive axillary dissection; 20 mg/day tamoxifen was prescribed for at least 2 years. We used multivariable analysis to take account of the lack of randomization.
  
  
  RESULTS
  After median follow-up of 15 years (interquartile range 14-17 years) there was no significant difference in breast cancer mortality between the axillary and no axillary clearance groups. Crude cumulative 15-year incidence of axillary disease in the no axillary dissection group was low: 5.8% overall and 3.7% for pT1 patients.
  
  
  CONCLUSIONS
  Elderly patients with early breast cancer and clinically negative nodes did not benefit in terms of breast cancer mortality from immediate axillary dissection in this nonrandomized study. Sentinel node biopsy could also be foregone due to the very low cumulative incidence of axillary disease in this age group. Axillary dissection should be restricted to the small number of patients who later develop overt axillary disease.
authors.affiliation: Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. gabriele.martelli@istitutotumori.mi.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Martelli
authors.forename: Rosalba
authors.initials: R
authors.lastname: Miceli
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Daidone
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vetrella
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Cerrotta
authors.forename: Domenico
authors.initials: D
authors.lastname: Piromalli
authors.forename: Roberto
authors.initials: R
authors.lastname: Agresti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate