Evidence map›Paper›PMID 35385998›Full record

ArticleAnnals of surgical oncology2022

Variation in Deescalated Axillary Surgical Practices in Older Women with Early-Stage Breast Cancer.

Christina A Minami, Ginger Jin, Mara A Schonberg, Rachel A Freedman, Tari A King, Elizabeth A Mittendorf

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.3field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 14 citations in OpenAlex.

  1. Review
  2. Survivorship Issues in Older Adults with Breast Cancer.Current breast cancer reports · 2025
    Article
  3. Article
  4. Article
  5. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Christina A MinamiDivision of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. cminami@partners.org.
Ginger JinCenter for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Mara A SchonbergDepartment of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Rachel A FreedmanBreast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Tari A KingDivision of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Elizabeth A MittendorfDivision of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Brigham and Women's Hospital · USBeth Israel Deaconess Medical Center · USDana-Farber Brigham Cancer Center · US

Funding

Research and mentoring program in shared decision making in the care of older adultsK24AG071906 · NIA · BETH ISRAEL DEACONESS MEDICAL CENTER · PI SCHONBERG, MARA A · 2021 to 2025
$946k
Locoregional Treatment Decision-making in Older Adults with Early-Stage, Hormone Receptor-Positive Breast CancerR03AG073986 · NIA · BRIGHAM AND WOMEN'S HOSPITAL · PI MINAMI, CHRISTINA A · 2021 to 2022
$258k
NIA NIH HHS K24 AG071906NIA NIH HHS R03 AG073986
6 · The paper itself

Abstract

backgroundRandomized controlled trials show that certain axillary surgical practices can be safely deescalated in older adults with early-stage breast cancer. Hospital volume is often equated with surgical quality, but it is unclear whether this includes performance of low-value surgeries. We sought to describe how utilization of two low-value axillary surgeries has varied by time and hospital volume.

methodsWomen aged ≥ 70 years diagnosed with breast cancer from 2013 to 2016 were identified in the National Cancer Database. The outcomes of interest were sentinel lymph node biopsy (SLNB) in cT1N0 hormone receptor-positive cancer patients and axillary lymph node dissection (ALND) in cT1-2N0 patients undergoing breast-conserving surgery with ≤ 2 pathologically positive nodes. Time trends in procedure use and multivariable regression with restricted cubic splines were performed, adjusting for patient, disease, and hospital factors.

resultsOverall, 83.4% of 44,779 women eligible for omission of SLNB underwent SLNB and 20.0% of 7216 patients eligible for omission of ALND underwent ALND. SLNB rates did not change significantly over time and remained significantly different by age group (70-74 years: 93.5%; 75-79 years: 89.7%, 80-84 years: 76.7%, ≥ 85 years: 48.9%; p < 0.05). ALND rates decreased over the study period across all age groups included (22.5 to 16.9%, p < 0.001). In restricted cubic splines models, lower hospital volume was associated with higher likelihood of undergoing SLNB and ALND.

conclusionsALND omission has been more widely adopted than SLNB omission in older adults, but lower hospital volume is associated with higher likelihood of both procedures. Practice-specific deimplementation strategies are needed, especially for lower-volume hospitals.

Identifiers

PMID35385998
PMCPMC9982465
OpenAlexW4226109548

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.