Axillary vs Sentinel Lymph Node Dissection for Invasive Breast Cancer

To the Editor: Dr Giuliano and colleagues found that women undergoing breast conserving therapy for T1-T2 invasive breast cancers with 1 or 2 positive SLNs did not benefit from ALND.¹ Giuliano et al previously reported that younger age (≤50 years) was an independent predictor of locoregional recurrence,² with an HR of 0.285, indicating that younger women were approximately 4 times more likely to experience a locoregional recurrence. Only 155 women in the current study were 50 years of age or younger and underwent SLN biopsy without ALND, making definitive statements about the absolute risk of locoregional recurrence in this subgroup difficult to state with certainty. We are concerned that these data could be applied to women younger than 50 years with inadequate data supporting safety. Could the authors provide additional information regarding the actual frequency (absolute rather than relative risk) and nature (breast vs axillary) of recurrence in younger women from the Z0011 trial?