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    Key Points
    • In this longitudinal study published in JAMA, researchers determined 5-year locoregional recurrence-free survival (LRFS) rate and disease-free survival (DFS) rate after sentinel lymph node biopsy (SLNB) and radiotherapy (RT) in 3361 women aged 70 years and older with early-stage, estrogen receptor–positive, ERBB2 (formerly HER2)–negative, clinically node-negative breast cancer.
    • The researchers found that SLNB can safely be omitted in elderly with ER-positive, clinically node-negative breast cancer. Similarly, radiotherapy can be omitted based on LRFS and DFS. Despite these findings, the authors noted that rates of RT and SLNB are high, thus requiring further study. “[I]n accordance with the CALGB 9343 trial,” they wrote, “low rates of locoregional recurrence with or without RT and low rates of pathological node positivity
    • With regard to limitations, the study did not cover predicted life expectancy, Eastern Cooperative Oncology Group performance status, socioeconomic status, or performance status, thus potentially leading to residual confounding. Additionally, if patients received care outside of the system, data could have been misclassified or underreported. Another limitation could be limited follow-up time in the study, with long-term data need to ascertain late recurrences that often occur with ER-positive tumors.