Author Affiliations: John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California (Dr Giuliano) (firstname.lastname@example.org); Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Morrow); and Mayo Clinic, Rochester, Minnesota (Dr Ballman).
In Reply: Dr Jatoi states that ER positivity prolongs time to distant relapse, but studies with extended follow-up do not indicate that it prolongs interval to axillary recurrence.1- 3 Moreover, because the proportion of ER-negative patients was identical in the 2 treatment groups of Z0011 (16.5% ALND, 16.3% SLND alone), the risk of late recurrences should be evenly distributed. Study results are unlikely to change substantially with further follow-up.
Giuliano AE, Morrow M, Ballman KV. Axillary vs Sentinel Lymph Node Dissection for Invasive Breast Cancer—Reply. JAMA. 2011;305(22):2288-2291. doi:10.1001/jama.2011.756