The 19th St. Gallen Breast Cancer Conference (SGBCC 2025) took place from March 12–15, 2025, in Vienna, Austria. On the third day (March 14), Professor Cicero Urban, Bioethics and Scientific Methodology, Positivo University Medical School Chair, The Department of Surgery at Our Lady of Grace Hospital, Curitiba, Brazil, gave a keynote lecture titled "Who can avoid upfront sentinel node and axillary surgery in node-negative and node-positive presentations?" After the lecture, Oncology frontier interviewed Professor Urban to elaborate on his views regarding the patient population suitable for axillary surgery in early breast cancer and his anticipation for consensus vote at SGBCC.Oncology frontier: The current applicability of axillary surgery (such as SLNB or ALND) in early-stage breast cancer is a subject of controversy. In your report at SGBCC, you mentioned that certain patients could avoid these surgeries. Could you discuss why there is a need to redefine the patient population for axillary surgery from the perspective of tumor biology or treatment development?
Professor Cicero Urban: Well, this is a great question. It was the point of my presentation, the key point in my presentation. I think that axilla in the upfront surgery will change in a few years. It is changing now because of 2023 and 2024 were big years for the trials and big discussions in axillary surgery. We can avoid sentinel node biopsy in patients that are T1, postmenopausal, luminal cancer, G1 and G2. These are patients with early breast cancer where we can avoid this kind of surgery. If we have axillary ultrasound, which is negative, so we can avoid sentinel node biopsy. And also if you have a clinically negative patient, but with one or two sentinel node biopsy, one or two sentinel nodes positive, it’s possible to avoid axillary dissection. We have very robust data in these patients. So we are de-escalating the axillary surgery. Maybe we will arrive in a point that instead of who can avoid axillary dissection, who can avoid sentinel node biopsy, rather than this, we will achieve in a point that we will, the real question will be who cannot avoid axillary surgery in the near future.
Oncology Frontier: As the SGBCC consensus vote approaches, what are your expectations for the consensus on exempting early-stage breast cancer patients from axillary surgery (such as SLNB or ALND)?
Professor Cicero Urban: Well, my expectation, and I hope I will have success on this, is that for these patients, low-grade tumors, T1, postmenopausal, luminal, that we can avoid sentinel node biopsy if we have negative axillary ultrasound . Let’s see.
