Med Care

BackgroundDespite clear guidelines for its use and wide adoption, no population-based study has examined the extent to which patients with early stage breast cancer are benefiting from sentinel lymph node biopsy (SLNB) by being spared a potentially avoidable axillary lymph node dissection (ALND) and its associated morbidity.ObjectiveExamine variation in type of axillary surgery performed by surgeon volume; investigate the extent and consequences of potentially avoidable ALND.Research design/subjectsObservational study of older women with pathologically node-negative Stage I\u2013II invasive breast cancer who underwent surgery in a SEER state in 2008\u20132009.MeasuresSurgeon annual volume of breast cancer cases and type of axillary surgery were determined by Medicare claims. An estimated probability of excess lymphedema due to ALND was calculated.ResultsAmong 7,686 pathologically node-negative women, 49% underwent ALND (either initially or after SLNB) and 25% were operated on by low volume surgeons. Even after adjusting for demographic and tumor characteristics, women treated by higher volume surgeons were less likely to undergo ALND (medium volume: OR 0.69 [95% CI 0.51\u20130.82]; high volume: OR 0.59 [95% CI 0.45 \u2013 0.76]). Potentially avoidable ALND cases were estimated to represent 21% of all expected lymphedema cases.ConclusionsIn this pathologically node-negative population-based breast cancer cohort, only half underwent solely SLNB. Patients treated by low volume surgeons were more likely to undergo ALND. Resources and guidelines on the appropriate training and competency of surgeons to assure the optimal performance of SLNB should be considered to decrease rates of potentially avoidable ALND and lymphedema.20182019-01-01T00:00:00ZHHSN261201000140C/CA/NCI NIH HHS/United StatesHHSN261201000035C/CA/NCI NIH HHS/United StatesR01 CA170945/CA/NCI NIH HHS/United StatesHHSN261201000035I/CA/NCI NIH HHS/United StatesHHSN261201000034C/CA/NCI NIH HHS/United StatesU58 DP003862/DP/NCCDPHP CDC HHS/United States29087982PMC5725235794