title: Time trends in axilla management among early breast cancer patients: Persisting major variation in clinical practice across European centers.
abstract: Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79-96% and 49-92% for pT1 and pT2 tumors, respectively. Axillary lymph node dissection (ALND) use for pT1 tumors decreased from between 75% and 27% in 2003 to 47% and 12% in 2010, and from between 90% and 55% to 79% and 19% for pT2 tumors, respectively. In 2014, important differences in axillary management existed for patients with micrometastases only, and for patients fulfilling the ACOSOG Z0011 criteria for omitting ALND. Conclusion This study demonstrates persisting differences in important aspects of axillary management throughout the recent decade. The results highlight the need for international comparative patterns of care studies in oncology, which may help to identify areas where further studies and consensus building may be necessary.
authors.affiliation: a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany ;
authors.forename: Adam
authors.initials: A
authors.lastname: Gondos
authors.affiliation: a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany ;
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: b Breast Unit , Women Hospital, National Center of Tumor Diseases, University Hospital, University of Heidelberg , Heidelberg , Germany ;
authors.forename: Jörg
authors.initials: J
authors.lastname: Heil
authors.affiliation: c Division of Gynecologic Oncology, National Center for Tumor Diseases , University Hospital , Heidelberg , Germany ;
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
authors.affiliation: d Department of Research , Netherlands Comprehensive Cancer Organisation , Utrecht , the Netherlands ;
authors.forename: Adri C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: e Department of Molecular Medicine and Surgery, Section of Breast Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: Jan
authors.initials: J
authors.lastname: Frisell
authors.affiliation: e Department of Molecular Medicine and Surgery, Section of Breast Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: Irma
authors.initials: I
authors.lastname: Fredriksson
authors.affiliation: e Department of Molecular Medicine and Surgery, Section of Breast Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: Ulla
authors.initials: U
authors.lastname: Johansson
authors.affiliation: f Department of Breast Surgery , Copenhagen University Hospital , Copenhagen , Denmark ;
authors.forename: Tove Filtenborg
authors.initials: TF
authors.lastname: Tvedskov
authors.affiliation: g Danish Breast Cancer Cooperative Group , Copenhagen , Denmark ;
authors.forename: Maj-Britt
authors.initials: MB
authors.lastname: Jensen
authors.affiliation: h Department of Pathology , Herlev Hospital , Herlev , Denmark ;
authors.forename: Eva
authors.initials: E
authors.lastname: Balslev
authors.affiliation: i Cancer Registry of Norway , Olso , Norway ;
authors.forename: Olaf Johan
authors.initials: OJ
authors.lastname: Hartmann-Johnsen
authors.affiliation: j Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine , Fondazione IRCCS Istituto Nazionale Dei Tumori , Milan , Italy ;
authors.forename: Milena
authors.initials: M
authors.lastname: Sant
authors.affiliation: j Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine , Fondazione IRCCS Istituto Nazionale Dei Tumori , Milan , Italy ;
authors.forename: Paolo
authors.initials: P
authors.lastname: Baili
authors.affiliation: k Breast Cancer Surgical Oncology Unit, Department of Surgical Oncology , Fondazione IRCCS Istituto Nazionale Dei Tumori , Milan , Italy ;
authors.forename: Roberto
authors.initials: R
authors.lastname: Agresti
authors.affiliation: l Tumor Registry, Department of Biometrics , the Netherlands Cancer Institute , Amsterdam , the Netherlands ;
authors.forename: Tony
authors.initials: T
authors.lastname: van de Velde
authors.affiliation: m Core Facility Molecular Pathology and Biobanking, Department of Molecular Pathology , the Netherlands Cancer Institute , Amsterdam , the Netherlands ;
authors.forename: Annegien
authors.initials: A
authors.lastname: Broeks
authors.affiliation: n Department of Mammo-Pelvic Surgery , Institute Jules Bordet , Brussels , Belgium ;
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Nogaret
authors.affiliation: o Service of Nuclear Medicine , Institute Jules Bordet , Brussels , Belgium ;
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourgeois
authors.affiliation: p Data Center , Institute Jules Bordet , Brussels , Belgium ;
authors.forename: Michel
authors.initials: M
authors.lastname: Moreau
authors.affiliation: q Department of Breast and Sarcoma Surgery , National Institute of Oncology , Budapest , Hungary ;
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Mátrai
authors.affiliation: q Department of Breast and Sarcoma Surgery , National Institute of Oncology , Budapest , Hungary ;
authors.forename: Ákos
authors.initials: Á
authors.lastname: Sávolt
authors.affiliation: r Department of Molecular Immunology and Toxicology , National Institute of Oncology , Budapest , Hungary ;|s Department of International Relations , National Institute of Oncology , Budapest , Hungary ;
authors.forename: Péter
authors.initials: P
authors.lastname: Nagy
authors.affiliation: t Center of Surgical Oncology , National Institute of Oncology , Budapest , Hungary ;
authors.forename: Miklós
authors.initials: M
authors.lastname: Kásler
authors.affiliation: u Division of Preventive Oncology , National Center for Tumor Diseases, and German Cancer Research Center , Heidelberg , Germany ;|v Huntsman Cancer Institute , Salt Lake City , Utah , USA ;
authors.forename: Petra
authors.initials: P
authors.lastname: Schrotz-King
authors.affiliation: u Division of Preventive Oncology , National Center for Tumor Diseases, and German Cancer Research Center , Heidelberg , Germany ;|v Huntsman Cancer Institute , Salt Lake City , Utah , USA ;|w German Cancer Consortium (DKTK) , Heidelberg , Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Ulrich
authors.affiliation: a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany ;|u Division of Preventive Oncology , National Center for Tumor Diseases, and German Cancer Research Center , Heidelberg , Germany ;|w German Cancer Consortium (DKTK) , Heidelberg , Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000368:Aged; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D005060:Europe; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data* / Q000639:trends; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D012042:Registries; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors