Society of Surgical Oncology

View all recommendations from this society

Released July 12, 2016; updated June 20, 2019; updated November 13, 2020; updated July 27, 2021

Don’t routinely use sentinel node biopsy in clinically node negative women ≥70 years of age with early stage hormone receptor positive, HER2 negative invasive breast cancer.

Endocrine therapy is standard treatment for all patients with hormone receptor positive breast cancer. The omission of sentinel lymph node biopsy in patients with non-palpable axillary lymph nodes in those women ≥70 years of age treated with endocrine therapy does not result in increased rates of locoregional recurrence and does not impact breast cancer mortality. Patients ≥ 70 years of age with early-stage, hormone receptor positive, HER2 negative breast cancer and no palpable axillary lymph nodes can be safely treated without axillary staging. Axillary staging can be individually considered, if the results may impact radiation therapy recommendations and/or systemic therapy decisions.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Society of Surgical Oncology (SSO) maintains disease site workgroups (DSWGs) to represent the various disease sites associated with surgical oncology. The DSWGs are comprised of experts in the following disease sites: gastrointestinal, melanoma/sarcoma, breast, hepatobiliary, endocrine/head & neck, colorectal and peritoneal surface malignancy. The SSO Quality Committee initiated the Choosing Wisely measure development process by asking the DSWGs to identify tests or procedures commonly used in their respective areas of expertise whose necessity should be questioned and discussed. The Quality Committee received submissions from six disease sites; however, because the list was limited to five measures, the Committee felt it was precluded from incorporating measures representing all disease sites. As a means of refining the list of Choosing Wisely measures, the Quality Committee elected to include the five measures impacting the largest number of patients. The draft list was reduced significantly – eliminating the gastrointestinal, endocrine, hepatobiliary, sarcoma and peritoneal surface malignancies measures. The five measures were selected from the breast, colorectal and melanoma sets. These five measures were submitted to and approved by the SSO Executive Council.

Quality Committee Members

  • Sandra Wong, MD, MS, Chair
  • David Shibata, MD, Vice Chair
  • Dave Bentrem, MD
  • Ned Carp, MD
  • Fabian Johnston, MD, MHS
  • Tari King, MD
  • Larissa Temple, MD
  • Sharon Weber, MD

Sources

Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, Muss HB, Smith BL, Hudis CA, Winer EP, Wood WC. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 2013 Jul 1;31(19):2382-7.

Martelli G, Miceli R, Daidone MG, Vetrella G, Cerrotta AM, Piromalli D, Agresti R. Axillary dissection versus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol. 2011 Jan;18(1):125–33.

Rudenstam CM, Zahrieh D, Forbes JF, et al., International Breast Cancer Study Group. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast
cancer: first results of International Breast Cancer Study Group Trial 10-93. J Clin Oncol 2006;24(3):337e44.

Chung A, Gangi A, Amersi F, Zhang X, Giuliano A. Not performing a sentinel node biopsy for older patients with early-stage invasive breast cancer. JAMA Surg 2015 Jul 1;150(7):683e4.
https://doi.org/10.1001/jamasurg.2015.0647.