Axilla Management Trials in Breast Cancer-A Requiem for Clinical Equipoise

Once upon a time, long ago, the National Adjuvant Breast and Bowel Project (NSABP) team asked two questions: (i) whether in patients with clinically negative nodes, total mastectomy with subsequent as needed axillary dissection is as effective as radical mastectomy, and whether, total mastectomy with subsequent as needed axillary dissection is as effective as total mastectomy plus postoperative regional radiation, and (ii) whether in patients with clinically node positive disease, total mastectomy plus postoperative regional radiation is equivalent to radical mastectomy.