Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Patient preferences for axillary dissection in sentinel lymph node positive early breast cancer (#158)

David WS Chang 1 2 , Mathias Bressel 3 , Carmen Hansen 4 , Prunella Blinman 5 , Penelope Schofield 6 , Boon Chua 7 8 9
  1. Children's Cancer Institute, Lowy Cancer Research Centre, Sydney, NSW
  2. Prince of Wales Hospital, Kensington, NSW, Australia
  3. Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  4. Mid North Coast Cancer Institute Radiation Oncology Unit, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
  5. Concord Cancer Centre, Concord, NSW, Australia
  6. Department of Psychological Sciences, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
  7. Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
  8. Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, Australia
  9. Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia


The Z0011 trial demonstrated no significant difference in axillary recurrence rate or survival with or without axillary lymph node dissection (ALND) in patients with a positive sentinel lymph node biopsy (SLNB) for early breast cancer. However, ALND may provide accurate pathological staging information to guide adjuvant therapy. Thus, the role of ALND after positive SLNB remains controversial.


The study aimed to determine patient preferences for ALND versus no further surgical intervention after a positive SLNB for early breast cancer. 


Patients who had undergone ALND after positive SLNB as part of breast conserving therapy for early breast cancer were provided with an introductory letter and a validated, self-rated questionnaire. The questionnaire comprised two trade-off questions based on standardised, hypothetical scenarios, and specifically stated that ALND might not provide a survival benefit. Social, demographic and clinical details were collected.


Ninety-nine of the 126 eligible patients (78.6%) completed and returned the questionnaire. The mean age of the participants was 61 years. Most women (92.1%) had 1–2 positive sentinel nodes. Seventy-five percent of participants indicated that they would have ALND even if the chance of side-effects that they had experienced with surgery was 100%. There was no significant association between the side effects that the participants had experienced and their preferences. Married patients were more likely to choose ALND than single patients (p<0.042).


Patients with early breast cancer were found to have a preference for ALND after positive SLNB for additional staging information without evidence of a survival benefit.