British women's choice between sentinel node biopsy and axillary node clearance for breast cancer

Background: Recent studies have demonstrated that the sentinel node biopsy (SNB), which utilises a simple principle, is a reliable and minimally invasive method for determining the status of the regional lymph nodes in patients with clinically node-negative breast cancer. The technique is increasingly being used in the management of patients with early breast cancer despite the lack of long-term data from randomised controlled trials which are currently in progress. However, increasing numbers of breast cancer patients are specifically requesting SNB in order to avoid axillary nodal clearance (ANC) if the sentinel node is negative for malignancy. The aim of this study is to determine the proportion of female patients attending a breast unit who would choose the SNB in preference to ANC. Methods: A detailed questionnaire, based on a utility analysis and containing clear and precise information on arm morbidity associated with ANC (1 in 10) versus a potential reduction in the 5-year-survival rate with SNB (1 in 1000) was distributed to 200 female patients attending the Princess Grace Hospital Breast Unit (London, UK) during January 2003. The questionnaire consisted of two possible treatment scenarios (ANC or SNB) for early-stage breast cancer with their associated risks and benefits, and participants were asked to choose one of the two options. Results: A total of 200 completed questionnaires were received. Out of the 200 women, 99 (49.5%) chose the SNB option and 101 (50.5%) chose the ANC option. There is no significant relationship between the option made with a woman's age (mean age: 53.4 vs 54), family history of breast cancer (p = 0.118), personal history of breast cancer (p = 0.85), or employment status (p = 0.96). Conclusion: This study demonstrates that a high level of acceptance exists among women for SNB as an alternative to ANC as the preferred treatment of early breast cancer, despite the risk involved. As this exciting technique continues to evolve and improve, it is hoped that more women will be given the choice to opt for this treatment and that eventually SNB may completely replace ANC as the standard treatment for early breast cancer.