Figure 1. Trends in Deimplementation of Low-Value Breast Cancer Operations Over Time for Patients Meeting Criteria for Omission of Procedure.

A, Axillary lymph node dissection for lumpectomy patients with 1 to 2 positive nodes receiving radiotherapy. B, Lumpectomy reoperation for patients receiving radiotherapy. C, Contralateral prophylactic mastectomy for patients with unilateral breast cancer. D, Sentinel lymph node biopsy for patients 70 years and older with clinically node-negative hormone receptor positive cancer. Axillary lymph node dissection and lumpectomy reoperation rates for patients meeting eligibility criteria decreased significantly after the release of guidelines supporting procedure omission. In contrast, rates of contralateral prophylactic mastectomy and sentinel lymph node biopsy for older women have increased from 2004 to 2016.