New Study Shows More Women With Early Breast Cancer Safely Skipping Lymph Node Surgery

A growing number of women diagnosed with early-stage breast cancer are choosing to skip a common surgical procedure, and new research suggests this trend is both safe and effective. The procedure, called sentinel lymph node biopsy (SLNB), has long been a standard part of breast cancer treatment. But for certain low-risk patients, doctors are now finding that less is often more.

According to a recent study presented at the American Society of Breast Surgeons meeting in Seattle, the number of women who opted out of SLNB for early breast cancer more than doubled over a five-year period. By 2025, it became the most common approach for women with low-risk disease. This shift marks a major change in how doctors think about treating early breast cancer.

What the Study Found

Researchers from the Mayo Clinic in Rochester, Minnesota, led by Dr. Matthew Hager, tracked 1,016 patients treated for low-risk breast cancer between 2020 and 2025. The results were striking:

• In 2020, only 25.5% of patients skipped SLNB. By 2025, that number had jumped to 50.9%.
• Among women aged 70 or older, 69% chose to skip the procedure over the five-year period.
• About one-third of patients between ages 50 and 69 also omitted SLNB.
• Nearly 80% of women who skipped SLNB received either partial breast irradiation (PBI) or no radiation therapy at all.

The study also found that more than 90% of women who did undergo SLNB had no signs of cancer in their lymph nodes. And among those who did have positive results, only 3 out of 62 patients went on to have a more extensive surgery called axillary lymph node dissection (ALND). This continues a broader trend toward less aggressive treatment for low-risk breast cancer.

Understanding Sentinel Lymph Node Biopsy

To understand why this matters, it helps to know what SLNB is. When a woman is diagnosed with breast cancer, doctors often want to check if the cancer has spread to nearby lymph nodes under the arm. SLNB involves removing one or a few of the first lymph nodes that would drain fluid from the breast. If those nodes are cancer-free, the disease likely has not spread.

For years, this procedure was considered essential for nearly all breast cancer patients. But experts now recognize that many women, especially those with low-risk tumors, may not need it. The surgery can cause side effects like arm swelling (lymphedema), pain, and limited arm movement. Avoiding it can improve quality of life without compromising cancer outcomes.

Why This Trend Is Growing

Dr. Hager explained that the shift started with older patients but has now spread to younger age groups. “We saw a significant increase in patients selected for sentinel lymph node surgery omission from 2020 to 2025, initially in the 70-and-older age group and more recently in the 50-to-69 age group,” he said.

Importantly, skipping the lymph node surgery did not lead to more aggressive radiation treatments. “Rates of radiation therapy and use of whole-breast irradiation did not increase,” Hager noted. “In fact, patients who were selected for omission of sentinel lymph node surgery had lower-risk disease and were more likely to have partial breast or omission of radiation compared to those who underwent sentinel lymph node surgery.”

He added, “With a multidisciplinary team approach, we are successfully de-escalating axillary surgery in appropriately selected patients without escalating radiation.”

What Experts Say About This Approach

Dr. Youssef Zeidan, an expert with the American Society for Radiation Oncology from the Lynn Cancer Institute and Baptist Health South Florida in Boca Raton, said these findings add to a growing body of evidence. “Endocrine therapy alone or in combination with radiation therapy represents a clinically viable approach,” he explained. However, he stressed that the best plan depends on the individual. “The optimal strategy requires careful multidisciplinary deliberation that incorporates patient preferences and individual risk profiles.”

Dr. Zeidan also pointed to two major studies, SOUND and INSEMA, which looked at skipping lymph node surgery. In those studies, most patients still received whole-breast irradiation. He cautioned that skipping radiation entirely requires extra caution in younger patients, who face a higher risk of cancer returning in the same breast. Two ongoing studies, EUROPA and DEBRA, are expected to provide more clarity on the best strategies for low-risk patients.

Guidelines Have Been Shifting for Years

This trend did not appear overnight. A decade ago, the Society of Surgical Oncology’s Choosing Wisely guidelines recommended against routine SLNB for patients over 70 with low-risk early breast cancer. The SOUND and INSEMA trials later extended that evidence to women over 50. Multiple studies have also shown that less aggressive radiation is safe for low-risk disease.

Dr. Hager noted a key concern: “Many of these trials omitting sentinel lymph node surgery generally required whole-breast irradiation, raising concern that omission of sentinel lymph node surgery could lead to escalation of radiation.” To address this, the Mayo Clinic implemented a policy where a multidisciplinary team decides on SLNB omission, with a clear agreement not to escalate radiation.

Detailed Results by Age Group

The study broke down the data by age, revealing clear patterns:

Patients aged 70 and older: In 2020, a majority (52.9%) already skipped SLNB. By 2022, that rate jumped to 79.4% and stayed around 80% through 2025. Among these patients, 69.1% did not have SLNB. Of those, almost half (48.6%) had partial breast irradiation, and 30% had no radiation at all. Among the older patients who did have SLNB, 56.3% received whole-breast irradiation.

Patients aged 50 to 69: In 2020, only 1.3% skipped SLNB. This rate remained around 1% until 2023, when it hit 3.2%. Then it rose sharply to 14.6% in 2024 and 32.8% in 2025. Among these younger patients, 7.7% skipped SLNB overall. Of those, 11% also skipped radiation, and 66.7% had partial breast irradiation. Even among younger patients who had SLNB, most received either partial breast irradiation (44.5%) or no radiation (5.8%).

Who Was Included in the Study

The analysis included patients aged 50 or older with tumors smaller than 5 centimeters. All had clinically node-negative, estrogen receptor-positive, HER2-negative breast cancer and were treated with breast-conserving surgery. The researchers looked at what type of axillary surgery (SLNB, ALND, or none) and what type of radiation (whole-breast, partial, or none) each patient received.

Patients who skipped SLNB tended to be older (average age 76 vs. 64), had smaller tumors, and were more likely to have low-grade disease. They also had a lower median proliferation score (8.0% vs. 10.0%), which measures how fast cancer cells are dividing.

What This Means for Patients

For women diagnosed with early breast cancer, this research offers reassuring news. It suggests that many can avoid an unnecessary surgery and its potential side effects without harming their chances of recovery. However, experts emphasize that this approach is not for everyone. It is specifically for women with low-risk, hormone receptor-positive, HER2-negative tumors who are treated with breast-conserving surgery.

If you or a loved one is facing a breast cancer diagnosis, here are some practical takeaways:

• Ask about your risk level. Not all breast cancers are the same. Your doctor can tell you if your tumor is considered low-risk based on its size, grade, hormone receptor status, and other factors.
• Discuss all options. Ask whether skipping SLNB might be appropriate for you. The decision should involve a team of specialists, including a surgeon, radiation oncologist, and medical oncologist.
• Consider your age. This study shows that the strongest evidence for skipping SLNB is in women over 70, but the trend is expanding to women in their 50s and 60s.
• Understand radiation choices. If you skip SLNB, you may still need radiation, but it might be a less intensive form like partial breast irradiation. In some cases, you may not need radiation at all.
• Weigh the pros and cons. Avoiding SLNB means avoiding the risks of surgery, anesthesia, and potential long-term side effects like lymphedema. But it also means you won’t have the full information that a lymph node biopsy provides.

The Bottom Line

The treatment of early breast cancer is becoming more personalized and less invasive for many women. This study from the Mayo Clinic shows that a growing number of patients are safely skipping sentinel lymph node biopsy, and this trend is accelerating. With careful selection and a team-based approach, doctors can offer effective treatment that minimizes unnecessary procedures and side effects.

As more research emerges, including results from the ongoing EUROPA and DEBRA trials, the guidelines for who can safely skip lymph node surgery are likely to expand further. For now, the message is clear: for many women with low-risk early breast cancer, less treatment can be just as effective — and often better — than more.

Source: MedPage Today