title: Unnecessary axillary surgery for patients with node-negative breast cancer undergoing total mastectomy.
abstract: OBJECTIVE
  To identify factors associated with the use of axillary lymph node dissection (ALND) as the initial axillary staging in node-negative breast cancer patients undergoing total mastectomy.
  
  
  METHODS
  California Cancer Registry study.
  
  
  METHODS
  Academic research.
  
  
  METHODS
  Women treated with total mastectomy for Tis, T1, or T2 node-negative breast carcinoma treated between January 1, 2004, and December 31, 2008.
  
  
  METHODS
  Proportions of patients who underwent ALND without prior sentinel lymph node dissection were compared by demographic characteristics.
  
  
  RESULTS
  Of 18,238 women treated with total mastectomy for Tis, T1, or T2 node-negative breast carcinoma, 35.1% underwent initial axillary staging by ALND without prior sentinel lymph node dissection. On multivariable analyses, patients were significantly more likely to undergo ALND if they had T2 disease or were 65 years or older, were hormone receptor negative, of Hispanic or Asian/Pacific Islander race/ethnicity, of lower socioeconomic quintile, operated on during earlier years of the study period, and not treated by a hospital cancer program approved by the American College of Surgeons.
  
  
  CONCLUSIONS
  More than one-third of patients in California who underwent total mastectomy for treatment of early-stage node-negative breast carcinoma received ALND without prior sentinel lymph node dissection; furthermore, certain subsets of patients have higher odds of undergoing ALND alone. To avoid the unnecessary morbidity of ALND in early-stage breast carcinoma, further research is required to elucidate how tumor, patient, and system factors can be modified to improve delivery of optimal breast cancer care.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Loma Linda University, Loma Linda, CA 92350, USA.
authors.forename: Windy
authors.initials: W
authors.lastname: Olaya
authors.forename: John W
authors.initials: JW
authors.lastname: Morgan
authors.forename: Sharon S
authors.initials: SS
authors.lastname: Lum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D015413:Mastectomy, Simple; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D019564:Unnecessary Procedures; D055815:Young Adult