Women's choice between sentinel lymph node biopsy and axillary clearance

Purpose: To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality. Methods: The expected 5-year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in Survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided Subjects with a scenario, and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists. Results: One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room Subjects chose SLNB rather than AC. Conclusions: Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC.