Dr Boughey on Defining Optimal Candidates For Surgical De-Escalation in Breast Cancer

Judy C. Boughey, MD, breast surgical oncologist, division chair, Breast and Melanoma Surgical Oncology, chair, Breast Cancer Disease Group, Mayo Clinic Comprehensive Cancer Center, discusses key characteristics that define the ideal population for surgical de-escalation among patients with breast cancer.

Within the breast cancer field, there is a growing emphasis on tailoring surgical interventions to individual patients to minimize potential surgical complications, Boughey begins. To identify the ideal candidates for surgical de-escalation, their specific patient characteristics and tumor biology are considered, Boughey states. Patients most suited for surgical de-escalation typically exhibit favorable prognostic features, she explains, indicating that they are likely to achieve responses despite undergoing less extensive surgery. This includes individuals with smaller tumors and biologically favorable tumor subtypes, such as luminal A breast cancers, Boughey notes.

The assessment of breast and axillary lymph nodes throughstandard imaging modalities also plays a pivotal role in surgical decision-making, Boughey continues. Recent efforts in surgical de-escalation have centered on avoiding axillary surgery whenever possible, Boughey says. To achieve this, clinicians must accurately identify patients with a high probability of developing negative lymph nodes, as these individuals are not likely to require lymph node removal, Boughey states. Patients who fit this profile are typically older, have small, low-grade tumors, and have favorable pathological features like tubular breast carcinoma or low Ki-67 expression, she details.

Clinicians confirm the presence of these clinical characteristics with imaging assessments, such as axillary ultrasound and magnetic resonance imaging, to ensure that lymph nodes appear normal, Boughey adds. By leveraging the available clinical and imaging data, clinicians can stratify patients who are most likely to display negative lymph nodes, Boughey says. This approach enables patients to avoid unnecessary axillary surgery, reducing disease burden, she emphasizes. Boughey concludes that this shift toward surgical de-escalation marks a promising advancement in breast cancer management.