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Despite interest in minimizing combination therapy (i.e., ALND+RNI) to avoid complications, concern remains over the oncologic safety of de-escalation in younger populations. This retrospective analysis explores the association between age and receipt of ALND+RNI to gain insight into patterns of axillary management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the National Cancer Database (2018\u20132020), age-based differences in ALND+RNI among patients with stage I\u2013III breast cancer undergoing surgery were examined. Patient and treatment characteristics were compared by age (&lt;45, 45\u201364, and \u226565 years). Multivariable regression assessed associations between age and treatment, adjusting for clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 439,790 patients, 7.5% were aged &lt;45 years, 45.2% were 45\u201364, and 47.3% were \u226565. Patients aged &lt;45 years (9.9%) were more commonly clinically node-positive (cN+) (vs 5.7% for age 45\u201364 and 5.5% for age \u226565 years;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). Younger patients were more likely to undergo ALND (23.8% vs 17.0% vs 16.3%), RNI (23.1% vs 16.9% vs 12.9%), and ALND+RNI (10.6% vs 6.2% vs 4.6%) (all\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). On multivariable analysis, age &lt;45 years had the highest odds of ALND+RNI (odds ratio 1.11; 95% confidence interval 1.03\u20131.20 vs \u226565 years) overall, but age did not impact ALND+RNI among those receiving neoadjuvant chemotherapy (\n                      <jats:italic>p<\/jats:italic>\n                      =0.209). On sensitivity analyses, those with cN+ molecular subtypes were more likely to receive ALND+RNI than those with clinical N0 disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women aged &lt;45 years are more likely to receive ALND+RNI. These data highlight an opportunity for further studies targeting management in younger cohorts to limit overtreatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19746-3","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T10:54:58Z","timestamp":1778237698000},"page":"7216-7228","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Receipt of Combined Axillary Dissection and Nodal Irradiation Varies by Age"],"prefix":"10.1245","volume":"33","author":[{"given":"Sara P.","family":"Myers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yevgeniya","family":"Gokun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Slover","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"shley P.","family":"Davenport","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"herese Y.","family":"Andraos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerea","family":"Lopetegui-Lia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"LeFebvre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Stover","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Mittendorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tari A.","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Kantor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"19746_CR1","volume-title":"Cancer Facts and Figures 2025","author":"American Cancer Society","year":"2025","unstructured":"American Cancer Society. 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TAK reports speaker honoraria for Exact Sciences, compensated service on the FES Steering Committee for GE Healthcare, compensated service for a Prosigna advisory board role for Veracyte, compensated service on the advisory board for Ataraxia AI, and compensated service as faculty for PrecisCa cancer information service. All remaining authors report no conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}