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The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer—10 Years after the ACOSOG Z0011 Trial First Publication

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020.

Patients and Methods

A survey of members of the Brazilian Society of Mastology.

Results

Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old.

Conclusions

This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.

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Acknowledgments

The authors are grateful to Fernanda Pereira Alves and Jéssica Telles Bonavita for their administrative work in providing the relevant data on the SBM members and to all the affiliated members of the SBM who participated in this study.

Funding

None.

Author information

Authors and Affiliations

  1. Breast Unit, Leblon Medical Center, Rio de Janeiro, Brazil

    Eduardo Camargo Millen PhD

  2. Breast Unit, Fortaleza General Hospital (HGF), Fortaleza, Brazil

    Francisco Pimentel Cavalcante MD

  3. School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

    Felipe Zerwes PhD

  4. Breast Unit, Hospital Israelita Albert Einstein, América Serviços Médicos, São Paulo, Brazil

    Guilherme Novita MD, MSc

  5. Breast Surgery Division, PUCRS, Porto Alegre, Brazil

    Alessandra Borba Anton de Souza MD, MSc

  6. Breast Center, Instituto Orizonti and Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brazil

    João Henrique Penna Reis MD

  7. School of Medicine, Federal University of Paraná, Curitiba, PR, Brazil

    Helio Rubens de Oliveira Filho MD, MSc, FACS

  8. Breast Unit, Real Hospital Português, Recife, Brazil

    Luciana Naíra de B. L. Limongi MD

  9. Breast Unit, Pace Hospital, Belo Horizonte, Brazil

    Barbara Pace Silva de Assis Carvalho PhD

  10. Breast Unit, Larmony Mastologia, Florianópolis, Brazil

    Adriana Magalhães de Oliveira Freitas MD

  11. Breast Unit, Samaritano Botafogo (Américas Serviços Médicos), Rio de Janeiro, Brazil

    Monica Travassos Jourdan MD

  12. School of Medical Sciences, Santa Casa de São Paulo, Head of the Breast Unit, Santa Casa de São Paulo, São Paulo, Brazil

    Vilmar Marques de Oliveira PhD

  13. Department of Obstetrics and Gynecology, CORA Advanced Center for Diagnosis of Breast Cancer, Federal University of Goiás, Goiânia, Brazil

    Ruffo Freitas-Junior PhD

Authors
  1. Eduardo Camargo Millen PhD
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  2. Francisco Pimentel Cavalcante MD
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  3. Felipe Zerwes PhD
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  4. Guilherme Novita MD, MSc
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  5. Alessandra Borba Anton de Souza MD, MSc
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  6. João Henrique Penna Reis MD
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  7. Helio Rubens de Oliveira Filho MD, MSc, FACS
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  8. Luciana Naíra de B. L. Limongi MD
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  9. Barbara Pace Silva de Assis Carvalho PhD
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  13. Ruffo Freitas-Junior PhD
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Contributions

E.C.M., F.P.C., G.N., F.Z., and R.F.J. participated in the conception and design of the study. All authors were involved in data collection. F.P.C., E.C.M., J.H.P.R., G.N., F.Z., A.B.A.S., and R.F.J. analyzed and interpreted the data. All authors contributed to the writing of the manuscript, approved the final version, and agree to be accountable for the work.

Corresponding author

Correspondence to Eduardo Camargo Millen PhD.

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Disclosures

The authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Declaration of Helsinki and its later amendments. This is a survey study. All of those who answered the questionnaire agreed to participate. The completed survey forms were maintained anonymous.

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Millen, E.C., Cavalcante, F.P., Zerwes, F. et al. The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer—10 Years after the ACOSOG Z0011 Trial First Publication. Ann Surg Oncol 29, 1087–1095 (2022). https://doi.org/10.1245/s10434-021-10812-6

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