Sentinel node biopsy questioned for some older women with breast cancer

Positive lymph node status is not a reliable indicator of the need for adjunctive chemotherapy, and sentinel node biopsy may not be helpful in older women with certain low-risk breast cancers, according to a study presented at the annual meeting of the American Society of Breast Surgeons, held from April 6 to 10 in Las Vegas.

Kyra Nicholson, M.D., from University of Chicago, and colleagues examined the distribution of the Oncotype DX breast recurrence scores in older women (older than 70 years) with hormone receptor-positive American Joint Committee on Cancer clinical stage I breast cancers and identified clinical factors associated with a high recurrence score. The analysis included 28,338 patients diagnosed from 2010 to 2018.

The researchers found that the strongest independent factor associated with an Oncotype DX score ≥26 was tumor grade 3 for both node-positive (odds ratio, 12.71) and node-negative (odds ratio, 18.00) patients, followed by negative progesterone receptor status (odds ratio, 6.20 for node-positive versus 7.19 for node-negative). Additionally, patients with larger tumors (>2 cm) and those on Medicaid were more likely to have an Oncotype DX score ≥26. Compared with other minority patients (Black and Asian), Hispanic patients tended to be less likely to have an Oncotype DX score ≥26.

"These findings suggest that sentinel node biopsy may not be helpful for adjuvant chemotherapy decisions in this patient population, but certain tumor factors may be more helpful," the authors write.