Identification of Populations at Risk for "Choosing Un-Wisely": A SEER Population-Based Study.
Am Surg
; 89(10): 4135-4141, 2023 Oct.
Article
en En
| MEDLINE
| ID: mdl-37259527
ABSTRACT
BACKGROUND:
Since 2016, the Choosing Wisely campaign has recommended against routine axillary surgery in elderly patients with early stage, hormone receptor positive (ER+) breast cancer. The objective was to evaluate factors associated with axillary surgery in breast cancer patients meeting criteria for sentinel lymph node biopsy (SLNB) omission and identify potential disparities.METHODS:
Female patients age ≥70 years with cT1-2N0M0, ER+, HER2-negative breast cancer diagnosed after publication of the Choosing Wisely recommendations, between 2016 and 2019, were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patient demographics and tumor characteristics associated with axillary surgery were analyzed.RESULTS:
Of the 31 756 patients meeting omission criteria, 25 771 (81.2%) underwent axillary surgery. Hispanic ethnicity, median household income between $35,000 and $70,000, treatment in rural areas, poor differentiation, lobular and mixed lobular with ductal histology, T2 tumors, radiation therapy, and systemic therapy were factors associated with receiving axillary surgery on multivariable analysis. In the axillary surgery cohort, a median of 2 (IQR = 2) nodes were examined and 529 (2.1%) patients were found to have 1 or more positive lymph nodes.DISCUSSION:
Among elderly patients meeting Choosing Wisely criteria for SLNB omission, particular racial, ethnic, socioeconomic, and geographic populations may be at increased risk for potential over treatment. Identification of these factors provides specific opportunities for education and implementation of de-escalation of unnecessary procedures.Palabras clave
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Base de datos:
MEDLINE
Asunto principal:
Neoplasias de la Mama
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Biopsia del Ganglio Linfático Centinela
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Guideline
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
Am Surg
Año:
2023
Tipo del documento:
Article