Management of Axilla in 2015 in Indian Scenario

Abstract

Sentinel lymph node biopsy is now increasingly being considered the favored method to treat low volume axilla. Most often this is followed by adjuvant radiation directed at axilla. In India however, sentinel node itself is still not widely practiced. The radiotherapy facilities are also not uniform, with cobalt units still being used in many centers. The long-term complications related to radiation are not assessed well. In fact there are also questions whether the evidence from early screen detected cancers in western population can be blindly followed in our population with a possibly different tumor biology and presentation as locally advanced being the norm. However, it is possible that we will see lesser axillary surgery in the minimal axillary disease group, in the not so distant future. We will look at the emerging evidence with an open mind and try to look at how this is applicable to our scenario.

Reconsidering axillary surgery for early breast cancer

“…However, to date, the major axillary surgery trials have been conducted in western countries where breast cancer patients often present with a low burden of axillary disease. It is unclear whether the results of these trials can be extrapolated to countries such as India, where the clinical setting is often very different 19 . Although the axillary surgery trials may be internally valid, their external validity (generalizability to other populations) remains a concern.…”

Practical consensus recommendations regarding the management of sentinel lymph node issues in early breast cancer

“…However, it is still not widely available across India. [23] For centers where SLNB is available/practiced, whether SLNB alone is sufficient for accurate staging of the axilla or does it require to be followed by ALND is an important question. The polled oncologists were presented with two different scenarios regarding the number of positive sentinel lymph nodes observed after SLNB and were asked whether they would recommend complete ALND.…”

Indian Solutions for Indian Problems—Association of Breast Surgeons of India (ABSI) Practical Consensus Statement, Recommendations, and Guidelines for the Treatment of Breast Cancer in India

“…For SLN assessment, routine molecular analysis was not recommended, and completion ALND is not mandatory after identification of micrometastasis in SLN but it should be mandatory if macrometastasis is identified in SLN. In current Indian scenario, the SLNB is now increasingly being considered the favored method to treat low-volume axilla, and various studies have proved its significance [17].…”