The time has come to change the algorithm for the surgical management of early breast cancer.

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Abstract
DURING THE PAST 100 years, new and less invasive methods to detect, diagnose, and treat early-stage breast cancer in women at risk for death due to the disease have been introduced. Large randomized trials have proved that breast conservation treatment saves the breast and results in long-term survival rates equivalent to those after modified radical mastectomy.1-7 Because clinicians have been unable to identify axillary metastases accurately using noninvasive methods,8-14 axillary lymph node dissection (ALND) has continued to be an integral part of breast cancer staging and regional control.15 However, numerous trials have demonstrated no improvement in overall survival after ALND vs observation for patients with clinically negative nodes.1,16-18 Moreover, because recommendations for adjuvant systemic therapy are often based primarily on characteristics of the primary tumor,19,20 ALND may no longer be necessary for this purpose.

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