Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy

Maria Grazia Lazzaretti, Antonio Ponti, Maria Piera Mano, Alessandra Barca, Denise Casella, Alfonso Frigerio, Livia Giordano, Paola Mantellini, Adriana Paduos, Sabina Pitarella, Alessandra Ravaioli, Mario Taffurelli, Mariano Tomatis, Nereo Segnan

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Available evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care.

MATERIAL AND METHODS: This is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50-69 between years 2000 and 2015 in twelve Italian Regions.

RESULTS: In pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45% of low grade, small DCIS over the whole time period had some form of axillary surgery.

CONCLUSION: This large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.

Original languageEnglish
Pages (from-to)15-22
Number of pages8
JournalBreast
Volume42
DOIs
Publication statusE-pub ahead of print - Aug 14 2018

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Sentinel Lymph Node Biopsy
Axilla
Italy
Carcinoma, Intraductal, Noninfiltrating
Breast Neoplasms
Mastectomy
Therapeutics
Publications
Cohort Studies
Retrospective Studies
Databases
Population
Neoplasms
Medical Overuse

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Lazzaretti, M. G., Ponti, A., Mano, M. P., Barca, A., Casella, D., Frigerio, A., ... Segnan, N. (2018). Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy. Breast, 42, 15-22. https://doi.org/10.1016/j.breast.2018.08.001

Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy. / Lazzaretti, Maria Grazia; Ponti, Antonio; Mano, Maria Piera; Barca, Alessandra; Casella, Denise; Frigerio, Alfonso; Giordano, Livia; Mantellini, Paola; Paduos, Adriana; Pitarella, Sabina; Ravaioli, Alessandra; Taffurelli, Mario; Tomatis, Mariano; Segnan, Nereo.

In: Breast, Vol. 42, 14.08.2018, p. 15-22.

Research output: Contribution to journalArticle

Lazzaretti, MG, Ponti, A, Mano, MP, Barca, A, Casella, D, Frigerio, A, Giordano, L, Mantellini, P, Paduos, A, Pitarella, S, Ravaioli, A, Taffurelli, M, Tomatis, M & Segnan, N 2018, 'Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy', Breast, vol. 42, pp. 15-22. https://doi.org/10.1016/j.breast.2018.08.001
Lazzaretti, Maria Grazia ; Ponti, Antonio ; Mano, Maria Piera ; Barca, Alessandra ; Casella, Denise ; Frigerio, Alfonso ; Giordano, Livia ; Mantellini, Paola ; Paduos, Adriana ; Pitarella, Sabina ; Ravaioli, Alessandra ; Taffurelli, Mario ; Tomatis, Mariano ; Segnan, Nereo. / Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy. In: Breast. 2018 ; Vol. 42. pp. 15-22.
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title = "Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy",
abstract = "OBJECTIVES: Available evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care.MATERIAL AND METHODS: This is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50-69 between years 2000 and 2015 in twelve Italian Regions.RESULTS: In pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45{\%} of low grade, small DCIS over the whole time period had some form of axillary surgery.CONCLUSION: This large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.",
author = "Lazzaretti, {Maria Grazia} and Antonio Ponti and Mano, {Maria Piera} and Alessandra Barca and Denise Casella and Alfonso Frigerio and Livia Giordano and Paola Mantellini and Adriana Paduos and Sabina Pitarella and Alessandra Ravaioli and Mario Taffurelli and Mariano Tomatis and Nereo Segnan",
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T1 - Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy

AU - Lazzaretti, Maria Grazia

AU - Ponti, Antonio

AU - Mano, Maria Piera

AU - Barca, Alessandra

AU - Casella, Denise

AU - Frigerio, Alfonso

AU - Giordano, Livia

AU - Mantellini, Paola

AU - Paduos, Adriana

AU - Pitarella, Sabina

AU - Ravaioli, Alessandra

AU - Taffurelli, Mario

AU - Tomatis, Mariano

AU - Segnan, Nereo

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018/8/14

Y1 - 2018/8/14

N2 - OBJECTIVES: Available evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care.MATERIAL AND METHODS: This is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50-69 between years 2000 and 2015 in twelve Italian Regions.RESULTS: In pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45% of low grade, small DCIS over the whole time period had some form of axillary surgery.CONCLUSION: This large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.

AB - OBJECTIVES: Available evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care.MATERIAL AND METHODS: This is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50-69 between years 2000 and 2015 in twelve Italian Regions.RESULTS: In pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45% of low grade, small DCIS over the whole time period had some form of axillary surgery.CONCLUSION: This large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.

U2 - 10.1016/j.breast.2018.08.001

DO - 10.1016/j.breast.2018.08.001

M3 - Article

C2 - 30138762

VL - 42

SP - 15

EP - 22

JO - Breast

JF - Breast

SN - 0960-9776

ER -