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June 8, 2011

Axillary vs Sentinel Lymph Node Dissection for Invasive Breast Cancer

Author Affiliations

Author Affiliations: Division of Surgical Oncology, University of Texas Health Science Center, San Antonio (

JAMA. 2011;305(22):2288-2291. doi:10.1001/jama.2011.750

To the Editor: Dr Giuliano and colleagues stated that “Axillary recurrence is usually an early event, occurring at a median of 14.8 months in [the National Surgical Adjuvant Breast and Bowel Project] B04 [trial]; in that trial, only 7 of 68 axillary recurrences occurred more than 5 years after study entry.”1,2 The authors then argued that, after a median follow-up of 6.3 years, further follow-up of patients in the American College of Surgeons Oncology Group Z0011 trial would not substantially alter the results of their study. Yet the authors ignored the fact that the risk of breast cancer recurrence is not only time-dependent but also dependent on tumor estrogen receptor (ER) status.

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