CARACAS, Venezuela – Oct. 26, 2025 – Venezuelan breast cancer specialists have issued new national guidelines for managing the armpit, or axilla, during and after treatment, aiming to improve patient care and align with international standards. The consensus, reached by 45 experts, addresses a rapidly evolving field where surgical approaches have dramatically shifted over the last three decades.
A Changing Landscape in breast cancer Surgery
The move towards less invasive techniques is at the heart of these updated recommendations. For years, axillary dissection – the removal of many lymph nodes – was standard practice. Now, the focus is increasingly on sentinel lymph node biopsy, a procedure that identifies and removes only the first few lymph nodes to which cancer cells are likely to spread.
What’s driving this change? Current treatment standards require carefully selecting breast cancer patients to achieve disease control with the least possible side effects and to positively impact their survival.
The Venezuelan Society of Mastology (SVM) convened the national Consensus to establish uniform criteria, optimize care, and improve the quality of life for Venezuelan patients. The guidelines consider both international best practices and the unique challenges within the venezuelan healthcare system.
“This consensus promotes a comprehensive, updated approach based on the best available evidence, which serves as a reference for specialized clinical practice in the country,” according to the document published in the Caracas Medical Gazette, the scientific dissemination body of the National Academy of Medicine (ANM) of Venezuela.
The guidelines emphasize the importance of treating all patients with breast pathology by specialists in mastology, given the complexity of current algorithms and the need for personalized medical indications.
The Board of Directors of the SVM (2023 – 2025) is chaired by Dr. VÃctor Acosta MarÃn,with Dr. humberto López Fernández serving as vice president, Dr. Elsa Di Leone as secretary, Dr. Adriana Pesci Feltri as undersecretary,Dr. MarÃa Teresa coutinho as treasurer, Dr. César Pacheco Porras as librarian, and Dr. Felipe Saldivia as a member.
Main coordination was provided by Dr. César Pacheco Porras, Dr. Felipe Saldivia, and Dr. VÃctor Acosta MarÃn. Specialty coordinators included Dr. Ana Karina RamÃrez (Pathological Anatomy), Dr. César Pacheco Porras (Surgery), Dr. Analisa Careddu (Imaging), Dr. MarÃa Teresa Coutinho (Medical Oncology), Dr. Fabio De Lima (Radiotherapy), and Dr.Itza Contreras (Nuclear Medicine).
The consensus document highlights the impact of clinical trials – including IBCSG 23-01,ACOSOG Z0011,SINODAR ONE,OTOASOR,and AMAROS – which have questioned the necessity of axillary lymphadenectomy in many cases of early breast cancer with minimal lymph node involvement. These trials have demonstrated a reduction in morbidity, especially the risk of lymphedema, by avoiding needless lymph node removal.
Recent trials, such as RxPONDER and monarchE, have also challenged traditional thresholds for systemic therapies based on the number of positive sentinel lymph nodes.
The SVM emphasized that these advances have increased the complexity of axillary surgical management, requiring careful patient selection and multidisciplinary collaboration to optimize outcomes and minimize complications.
The consensus addressed a range of clinical scenarios, including the management of clinically negative or positive axilla, the use of neoadjuvant therapy, and axillary recurrence. Working groups comprised of surgeons, imaging scientists, anatomopathologists, medical oncologists, radiotherapists, and nuclear doctors developed academic material and debated key questions within each specialty.
The resulting document,the SVM stated,can serve as a reference for other countries seeking to update their own guidelines for axillary management in breast cancer.
Additionally, the Caracas Medical Gazette published SVM recommendations on radiotherapy for the axillary approach in patients with breast cancer.
