No Axillary Surgery for Early Breast Cancer.

After national breast cancer screening was introduced in Sweden in 1989-90 the number of early invasive BC, clin N0 rose dramatically. Only 10 % or less of these was N+ after axillary dissection with a substantial morbidity after the axillary intervention. Omitting axillary dissection in a randomized trial was ruled out because of anticipated few events. A national cohort was decided for invasive unifocal BC, Screening or clinical diagnosis were eligible, only histological grade 1 or 2, T=max 10mm, free margins , clinical node negative. No axillary dissection should be undertaken, only radical removal of the breast cancer. (Note; This was before the Sentinel Node era). Adjuvant treatment could be given according to regional guidelines for early breast cancer as no regular national guidelines existed then concerning postoperative radiotherapy and antihormonal treatment. Chemotherapy was not recommended to this type of breast cancer. Follow-up was done by the treating surgeon the first 5 years including mammography. Then hospital records including mammography and reports from Pathology and Oncology and Death register were followed at intervals 5, 10 and 15 years. Primary aim: Number of axillary recurrence and distant metastases/ BC specific survival. Correlation to adjuvant therapy. Inclusion started in 1997 and ended in 2002. 1584 patients were included. If the axillary recurrence rate was more than 1% per year the first five years the inclusion should be stopped.

Inclusion criteria

• Invasive breast cancer, unifocal
• T=max 10mm
• Clinical node negative and clinical M0
• Histological grade 1 or 2
• Both screening / clinical detected accepted
• Radical operation = free margins in breast specimen
• Partial mastectomy and mastectomy accepted
• Fit to understand inclusion criteria

Exclusion criteria

• Previous breast cancer diagnosis, including carcinoma in situ
• Previous ipsilateral axillary dissection
• Non radical operation = no free margins
• Multifocal cancer
• Previous treatment for other cancer.
• Unable to understand information (informed consent)
• Bilateral breast cancer at diagnosis