Less is more”—so goes the adage, and that certainly has been the case for breast cancer. Forty years ago, the standard treatment for this disease was the Halsted radical mastectomy, an aggressive operation that involved removal of not only the breast but also the adjacent musculature and axillary lymph nodes. Better understanding of breast cancer biology revealed that aggressive surgical therapy alone was inadequate. As treatment approaches evolved away from extensive surgery, axillary lymph node dissection (ALND) remained part of the treatment regimen to detect nodal disease. Axillary lymph node metastases were considered an indicator that systemic disease was present, identifying a need for chemotherapy.
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