Expectation Versus Reality: Impact of the Choosing Wisely Campaign on Routine Use of Sentinel Lymph Node Biopsy in Women Over 70 With Early-Stage Breast Cancer in an Academic Institution.

INTRODUCTION: In 2016, the Society of Surgical Oncology issued a Choosing Wisely recommendation to omit routine sentinel lymph node biopsy (SLNB) in patients  ≥ 70 years of age with early stage, low risk, clinically node-negative, hormone receptor positive, and human epidermal growth factor receptor 2 negative breast cancer. This study aimed to evaluate surgical practice within an academic institution since the campaign's inception. We hypothesize that younger age, larger tumor size, and perceived higher risk histology would lead to a higher prevalence of SLNB.

METHODS: A retrospective chart review of patients who met Choosing Wisely Campaign criteria and underwent a lumpectomy at a tertiary care center from July 2016 to December 2020 was performed.

RESULTS: Younger patients (74 years vs. 80, P < .001) tended to have an SLNB performed, and those who underwent SLNB tended to undergo radiation (P < .05). Larger tumor size and a lobular histology-type trended toward a higher prevalence of SLNB without statistical significance. There was no difference in locoregional or distant recurrence in patients who underwent SLNB versus no axillary surgery.

CONCLUSION: The majority of women who meet the Choosing Wisely campaign criteria continue to undergo SLNB despite the fact that the recurrence rates and disease-related mortality remain low in this patient population.