Skipping armpit surgery for small, low-risk breast cancers
Same five-year results with less arm swelling, in one large trial.
What studies found
In the INSEMA trial (NEJM 2024; 4,858 women in the main analysis), women with tumors up to 5 cm and normal-seeming lymph nodes who had a lumpectomy and radiation either had sentinel node surgery or none. Five-year invasive disease-free survival was 91.9% without it and 91.7% with it, and those who skipped it had less lymphedema, better arm movement and less pain.
The catch
The American Society of Breast Surgeons says skipping it suits mainly women over 50 with tumors up to 2 cm that are hormone receptor-positive, HER2-negative and grade 1 or 2. Lymph node results can still guide treatment for others.
What to do
If your cancer is small and low-risk, ask your surgeon whether armpit surgery is needed.
Sources
Rung 4 of 5, Strong: At least one large randomized trial, or very large consistent studies, on this exact question. How we score
Step by step
For the whole picture, from prevention and screening to treatment and life after, see the breast cancer page.
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