Live MediSum Demo

This single-institution retrospective review of 1,016 breast cancers in women ≥50 with cT1/cT2 ER+/HER2− disease treated with lumpectomy found omission of sentinel lymph node (SLN) surgery increased from 25.5% in 2020 to 50.9% in 2025. Patients selected for SLN omission were older and lower risk, and SLN omission was associated with lower overall radiotherapy use, more partial-breast irradiation, and higher rates of RT omission rather than escalation of whole-breast irradiation.

Using a single‑institution registry of 1,194 women with cT1N0, ER+/HER2‑, grade 1–2 breast cancer who would be candidates for sentinel lymph node biopsy (SLNB) omission, 10.9% had ≥1 positive sentinel node (0.4% had ≥4 nodes), with nodal positivity decreasing with age and increasing with tumor size and grade. Under current guidelines, omitting SLNB would have altered eligibility for CDK4/6 inhibitors and partial breast irradiation in 18% of women <50 and 8.8% of women ≥50, whereas occult nodal positivity was very low (2.1%) in women ≥60 with grade 1 cT1a/b tumors.

In a SEER analysis of 532,118 women aged ≥50 years undergoing breast‑conserving surgery, receipt of radiotherapy (RT) was associated with improved breast cancer‑specific survival across all ages, but the relative benefit attenuated with older age (IPTW‑adjusted HRs from 0.54 in ages 50–54 to 0.81 in ≥85; p for interaction <0.001). Absolute risk reductions also decreased with age (approximately 5.2–5.6% in younger patients versus 2.9–3.7% in those aged 70–84), with spline analyses showing a gradual, not abrupt, decline in RT‑associated benefit with increasing age.