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Sentinel lymph node biopsy (SLNB) allows for staging of the axillary node status in early-stage breast cancer (BC) patients and avoiding complete axillary lymph node dissection (ALND) when the sentinel lymph node (SLN) is proven to be free of disease. In a previous randomized trial we compared SLNB followed by ALND (ALND arm) with SLNB followed by ALND only if the SLN presented metastasis (SLNB arm). At a mid-term of ≈ 6 years median follow-up, the two strategies appeared to ensure similar survival and locoregional control. We have revised these previous findings and update the results following a 15-year observation period. Patients were randomly assigned to either the ALND or SLNB arm. The main endpoints were event-free survival (EFS), overall survival (OS), and axillary disease recurrence. EFS and OS were assessed using Kaplan–Meier analysis and the log-rank test. The ALND and SLNB arms included 115 and 110 patients, respectively. At 14.3 years median follow-up, 39 primary BC-related recurrences occurred, 22 (19 %) of which occurred in the ALND arm and 17 (16 %) occurred in the SLNB arm (p = 0.519). No axillary relapse developed in the SLNB arm, while two were observed in the ALND arm. OS (82.0 vs. 78.8 %) and EFS (72.8 vs. 72.9 %) were not statistically different between the ALND and SLNB arms (p = 0.502 and 0.953, respectively). SLNB is a safe and efficacious component of the surgical treatment of early-stage BC patients. In the long-term, SLNB is equivalent to ALND in terms of locoregional nodal disease control and survival in this subset of patients.

The medical records of all women (297 cases) with breast cancer > or = 70 years of age, presenting at our Institute from January 1980 to December 1989, were reviewed. Data from 226 elderly women was compared to that from 100 stage-matched patients < 50 years of age, presenting during the same 10-year study interval. Conservative surgery was significantly more frequent in young patients (71.1%) compared to elderly women (26.1%) and radical mastectomy according to Halsted was undertaken in 34.3% of the elderly group compared to 8.9% of young patients (p < 0.001). Since 'incidental' diagnosis was significantly more frequent in the elderly group (59.9% versus 6.0%) (p < 0.001), primary care physicians may play an important role in the early diagnosis of breast cancer in the majority of elderly women.