Abstract
Early breast cancer is treated with curative intent by a network of incredibly interconnected disciplines. There are certain points in each discipline’s decision-making that can affect one of the others, and one such point is axillary surgery. Because removing all the lymph nodes from the cancer-containing historically provided the most accurate lymph node information to other disciplines, standard-of-care axillary surgery had been removal of all axillary lymph nodes with an axillary lymph node dissection (ALND). The benefit of an accurate ALND was soon outweighed, though, by its plethora of associated morbidities. This sparked numerous landmark clinical trials that ultimately demonstrated the safety of ALND omission. Following these trials there has been a trend toward de-escalating axillary surgery whenever possible. This review will explore the remaining questions in upfront axillary surgical management, specifically focusing on hormone receptor-positive (HR+) breast cancer patients, and the accompanying challenges for systemic therapy administration decisions.