{
  "abstract": "Purpose\n\nDe-escalation has become standard across breast cancer management. Many early-stage HR+/HER2-negative breast cancers are eligible for both SLNB omission and accelerated partial breast irradiation (APBI). However, the oncologic safety of dual de-escalation has not been evaluated except in patients ≥ 70 years. We sought to characterize national practice patterns and factors associated with adoption of this dual de-escalation approach.Methods\n\nWomen aged 50-69 years with clinical T1-T2N0 breast cancer who underwent upfront breast-conserving surgery between (2012 - 2022) were identified from the National Cancer Database. Patients were categorized by axillary surgery and by adjuvant radiation modality (WBI, APBI, or none). We assessed trends and factors associated with de-escalation.Results\n\n316,324 patients met inclusion criteria, of whom 98% underwent SLNB. Among patients who underwent SLNB, 83% received WBI, 11% received APBI, and 6% received no radiation. In contrast, among patients in whom SLNB was omitted, 63% received WBI, 8% received APBI, and 30% received no radiation. SLNB omission remained low throughout the study period at < 3%, while APBI use increased from 8% to 16.5%. Dual de-escalation was rarely performed throughout the study period remaining < 0.30%. Shared predictors of de-escalation included cT1 tumors, ductal histology, low grade, and treatment at academic/research programs.Conclusion\n\nThese findings highlight the need for prospective studies to define the safety, outcomes, and patient selection criteria for combined de-escalation strategies. Until these data are available, patient-centered discussions are essential to determine the most appropriate strategy for patients with low-risk disease.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Breast Surgery, Department of Surgery, Fox Chase Cancer Center, 333 Cottman Ave, c308, Philadelphia, PA, 19111, USA.",
    "Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.",
    "Research Institute, Endeavor Health, Evanston, IL, USA.",
    "Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.",
    "Division of Breast Surgery, Department of Surgery, Fox Chase Cancer Center, 333 Cottman Ave, c308, Philadelphia, PA, 19111, USA. austin.williams@fccc.edu."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Dylan S Brokaw"
    },
    {
      "affs": [
        0
      ],
      "name": "Leonardo Kozian"
    },
    {
      "affs": [
        2
      ],
      "name": "Cecilia Chang"
    },
    {
      "affs": [
        3
      ],
      "name": "Rebecca M Shulman"
    },
    {
      "affs": [
        0
      ],
      "name": "Richard J Bleicher"
    },
    {
      "affs": [
        0
      ],
      "name": "Alycia So"
    },
    {
      "affs": [
        0
      ],
      "name": "Allison A Aggon"
    },
    {
      "affs": [
        4
      ],
      "name": "Austin D Williams"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/by8sqk46wb0gm.bib",
  "cited_by": 0,
  "doi": "10.1007/s10549-026-08106-0",
  "fulltext_url": "https://europepmc.org/articles/PMC13677617",
  "id": "by8sqk46wb0gm",
  "issns": [
    "0167-6806",
    "1573-7217"
  ],
  "landing_url": "https://europepmc.org/article/MED/42894070",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "1306|Breast Cancer Treatment Studies"
    ]
  ],
  "openalex": "W7222879792",
  "pdf_url": "https://europepmc.org/articles/PMC13677617?pdf=render",
  "pmcid": "PMC13677617",
  "pmid": "42894070",
  "published": "2026-10-18",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/by8sqk46wb0gm.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:33Z",
      "native_id": "MED:42894070",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42894070"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:1306|Breast Cancer Treatment Studies",
      "subfield": "oncology"
    }
  ],
  "title": "National trends in dual de-escalation of axillary surgery and adjuvant radiation in early-stage HR+/HER2- breast cancer.",
  "title_text": "National trends in dual de-escalation of axillary surgery and adjuvant radiation in early-stage HR+/HER2- breast cancer.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:33Z",
  "url": "https://research.draconitic.com/paper/by8sqk46wb0gm",
  "venue": "Breast cancer research and treatment",
  "versions": []
}