Breast cancer surgery has seen major shifts in the past thirty years. One key change was the ACOSOG Z0011 trial. This trial suggested that some women with early-stage breast cancer might not need full axillary clearance. This is a procedure where lymph nodes under the arm are removed. The trial showed that for women with a low disease burden, a complete axillary clearance wasn't always necessary after a sentinel node biopsy (SLNB).

The findings from the trial were not immediately accepted. There were issues with the trial's design. This led to delays in its widespread use and varied practices around the world. A recent review looked at how the Z0011 trial and similar studies have affected axillary surgery rates. The review searched multiple databases and found 1362 papers. Out of these, 30 papers were included. These papers covered data from 290, 754 women across nine countries. All the studies were retrospective cohort studies.

The review found a clear trend: the rate of axillary lymph node dissection (ALND) has gone down since the Z0011 trial was published. The reduction in axillary clearance rates varied widely, from 5. 6% to 73. 4%. This shows that the Z0011 trial has indeed changed medical practice. However, the review also pointed out that only a small number of patients qualify for this de-escalation. This is due to the strict criteria set by the trial.

Most of the studies came from Western countries and research-focused hospitals. This limits how widely the findings can be applied. More research is needed to see how the Z0011 trial has been implemented globally. It's important to understand if these changes are happening in different settings. This way, doctors can better decide on the best treatment for their patients.

The review highlights the need for more inclusive research. It's crucial to look at data from various settings to get a full picture. This can help ensure that all patients benefit from the latest medical advancements. It's also important to consider the broader context of breast cancer treatment. Factors like patient preferences, healthcare systems, and cultural differences can all play a role. By understanding these aspects, doctors can provide more personalized and effective care.

How Breast Cancer Surgery Has Changed Over Time

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