With the introduction of CDK4/6 inhibitors for patients with early breast cancer, with criteria of either ≥ 4 positive lymph nodes or 1–3 positive lymph nodes with high-risk cancer features, a multidisciplinary approach is still needed for discussion of ALND omission.24 Lastly, radiation techniques have improved with potentially less morbidity than ALND. This evidence concerns the gene CDK4 and cancer.