Scholars@Duke
Ton Wang

Ton Wang

Assistant Professor of Surgery
Surgical Oncology
ton.wang@duke.edu
4101 Macon Pond Road, Raleigh, NC 27607
4101 Macon Pond Road, Raleigh, NC 27607

Selected Publications

Radiation De-Escalation in Older Women with Early-Stage ER+/HER2- Invasive Breast Cancer.

Journal Article Ann Surg Oncol · November 23, 2025 BACKGROUND: National recommendations since 2004 have allowed for omission of post-lumpectomy radiotherapy for patients ≥70 years old with early-stage estrogen receptor positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer. ... Full text Link to item Cite

The association of race and ethnicity with risk-reducing mastectomies in patients with non-BRCA mutations.

Journal Article Am J Surg · September 2025 INTRODUCTION: We compared rates of risk reducing mastectomies (RRM) in patients with breast cancer (BC)-related pathogenic variants. METHODS: Female patients ages ≥18 with a BC-related pathogenic variant, without a concurrent or prior BC diagnosis, were id ... Full text Link to item Cite

Risk Stratification for Sentinel Lymph Node Positivity in Older Women With Early-Stage Estrogen Receptor-Positive/Human Epidermal Growth Factor Receptor 2 Neu-Negative Invasive Breast Cancer.

Journal Article JCO Clin Cancer Inform · March 2025 PURPOSE: Guidelines recommend omission of sentinel lymph node biopsy (SLNB) for axillary staging in select patients age 70 years and older with early-stage estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 neu-negative (HER2-) inva ... Full text Link to item Cite

The association of genetic testing timing and mutation type on breast cancer management in patients with breast cancer-related mutations.

Journal Article Am J Surg · January 2025 BACKGROUND: We aim to characterize breast management for patients with genetic mutations and concurrent breast cancer (BC) or prior BC treatment. METHODS: Adults with a BC-related mutation and prior/concurrent BC diagnosis were identified. Groups were stra ... Full text Link to item Cite

Subsequent percutaneous breast biopsies after initial atypia diagnosis: The patient burden of long-term follow up.

Journal Article Am J Surg · January 2025 BACKGROUND: Breast atypia increases overall breast cancer risk, potentially necessitating future interventions. This study examines the frequency and outcomes of additional percutaneous biopsies after an atypia diagnosis. METHODS: Adult patients with breas ... Full text Link to item Cite

Omission of Axillary Lymph Node Dissection in Patients with Residual Nodal Disease After Neoadjuvant Chemotherapy.

Conference Ann Surg Oncol · December 2024 BACKGROUND: Axillary management after neoadjuvant chemotherapy (NAC) is evolving but axillary lymph node dissection (ALND) remains the standard of care for patients with residual nodal disease. The results of the Alliance A011202 trial evaluating the oncol ... Full text Link to item Cite

Demographics and Clinical Decision Making in Patients with Germline Moderate Penetrance Non-BRCA Mutations in Breast Cancer Related Genes.

Journal Article Ann Surg Oncol · October 2024 BACKGROUND: Management of pathogenic variants in high penetrance genes related to breast cancer (BC), such as BRCA1 and BRCA2, are well established. However, moderate penetrance mutations are understudied. We aim to compare risk reduction decision-making p ... Full text Link to item Cite

Utility of Axillary Staging in Older Patients with HER2-Positive Breast Cancer.

Journal Article Ann Surg Oncol · October 2024 BACKGROUND: The utility of sentinel lymph node biopsy (SLNB) in older patients remains controversial. Advancements in human epidermal growth factor receptor 2 (HER2)-directed therapy have revolutionized disease response rates and prognosis, supporting effo ... Full text Link to item Cite

Pilot testing a patient decision aid as a strategy to reduce overtreatment for older women with early-stage breast cancer.

Journal Article Am J Surg · September 2024 BACKGROUND: Despite national guidelines recommending omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy (RT) in older women with early-stage, hormone receptor-positive (HR+) breast cancer, these practices persist. This pilot stu ... Full text Link to item Cite

Comparison of Clinical Breast Exam to Breast MRI Surveillance in Patients Following Nipple-Sparing Mastectomy.

Journal Article Clin Breast Cancer · July 2024 BACKGROUND: Nipple sparing mastectomy (NSM) is increasingly being performed for patients with breast cancer. However, optimal postoperative surveillance has not been defined. METHODS: A prospectively maintained database identified patients with in-situ and ... Full text Link to item Cite

Understanding Treatment Decision-Making in Older Women With Breast Cancer: A Survey-Based Study.

Journal Article J Surg Res · April 2024 INTRODUCTION: For women ≥70 y old with early-stage hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, the national guidelines recommend the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiother ... Full text Link to item Cite

Radiation Management for Breast Cancer After Neoadjuvant Therapy

Journal Article Current Breast Cancer Reports · December 1, 2023 Purpose of Review: Neoadjuvant chemotherapy (NAC) utilization is an important part of breast cancer therapy. Recent advances call into question the optimal role of radiotherapy after NAC, as many radiation studies were performed without NAC. This review wa ... Full text Cite

De-Implementation of Low-Value Care for Women 70 Years of Age or Older with Low-Risk Breast Cancer During the COVID-19 Pandemic.

Journal Article Ann Surg Oncol · December 2023 BACKGROUND: Older women with early-stage estrogen receptor-positive (ER+) invasive breast cancer (IBC) are at risk for overtreatment. Guidelines allow for sentinel lymph node biopsy (SLNB) and radiotherapy omission after breast-conserving surgery (BCS) for ... Full text Link to item Cite

Incorporating Value-Based Decisions in Breast Cancer Treatment Algorithms.

Journal Article Surg Oncol Clin N Am · October 2023 Given the excellent prognosis and availability of evidence-based treatment, patients with early-stage breast cancer are at risk of overtreatment. In this review, we summarize key opportunities to incorporate value-based decisions to optimize the delivery o ... Full text Link to item Cite

Avoiding Overtreatment of Women ≥70 With Early-Stage Breast Cancer: A Provider-Level Deimplementation Strategy.

Journal Article J Surg Res · April 2023 INTRODUCTION: National guidelines recommend against routine axillary staging with sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy (RT) in women ≥70 y with early-stage, hormone receptor-positive, HER2-negative breast cancer and clinically negati ... Full text Link to item Cite

Facility-Level Variation of Low-Value Breast Cancer Treatments in Older Women with Early-Stage Breast Cancer: Analysis of a Statewide Claims Registry.

Journal Article Ann Surg Oncol · April 5, 2022 BACKGROUND: Since 2004, national guidelines have supported the omission of sentinel lymph node biopsy (SLNB) and radiotherapy for women ≥ 70 years of age with early-stage, hormone receptor-positive (HR+) breast cancer, but many women continue to receive at ... Full text Link to item Cite

Using Tailored Messages to Target Overuse of Low-Value Breast Cancer Care in Older Women.

Journal Article J Surg Res · February 2022 BACKGROUND: National recommendations allow for the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women ≥ 70 y/o with early-stage, hormone-receptor positive invasive breast cancer, but these therapies remain common. Previ ... Full text Link to item Cite

Incremental Spending Associated with Low-Value Treatments in Older Women with Breast Cancer.

Journal Article Ann Surg Oncol · February 2022 BACKGROUND: In most women ≥ 70 years old with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy provide no survival advantage over surgery and hormone therapy alone. Despite recommendations for their omission, sentinel lym ... Full text Link to item Cite

Statewide Episode Spending Variation of Mastectomy for Breast Cancer.

Conference J Am Coll Surg · January 1, 2022 BACKGROUND: Centralizing complex cancer operations, such as pancreatectomy and esophagectomy, has been shown to increase value, largely due to reduction in complications. For high-volume operations with low complication rates, it is unknown to what degree ... Full text Link to item Cite

A Health Systems Ethical Framework for De-implementation in Health Care.

Journal Article J Surg Res · November 2021 INTRODUCTION: Unnecessary health care not only drive up costs, but also contribute to avoidable patient harms, underscoring an ethical obligation to eliminate practices which are harmful, lack evidence, and prevent spending on more beneficial services. To ... Full text Link to item Cite

A novel C-terminal Hsp90 inhibitor KU758 synergizes efficacy in combination with BRAF or MEK inhibitors and targets drug-resistant pathways in BRAF-mutant melanomas.

Journal Article Melanoma Res · June 1, 2021 Melanoma remains the most aggressive and fatal form of skin cancer, despite several FDA-approved targeted chemotherapies and immunotherapies for use in advanced disease. Of the 100 350 new patients diagnosed with melanoma in 2020 in the US, more than half ... Full text Link to item Cite

Trends in Contralateral Prophylactic Mastectomy Utilization for Small Unilateral Breast Cancer.

Journal Article J Surg Res · June 2021 BACKGROUND: For average-risk women with unilateral breast cancer, contralateral prophylactic mastectomy (CPM) offers no survival benefit and contributes to increased costs and patient harm. Despite recommendations from professional societies against CPM, u ... Full text Link to item Cite

LIMIT is an immunogenic lncRNA in cancer immunity and immunotherapy.

Journal Article Nat Cell Biol · May 2021 Major histocompatibility complex-I (MHC-I) presents tumour antigens to CD8+ T cells and triggers anti-tumour immunity. Humans may have 30,000-60,000 long noncoding RNAs (lncRNAs). However, it remains poorly understood whether lncRNAs affect tumour immunity ... Full text Link to item Cite

Variations in Persistent Use of Low-Value Breast Cancer Surgery.

Journal Article JAMA Surg · April 1, 2021 IMPORTANCE: Through the Choosing Wisely campaign, surgical specialties identified 4 low-value breast cancer operations. Preliminary data suggest varying rates of deimplementation and have identified patient-level and clinician-level determinants of continu ... Full text Link to item Cite

Gaps in Online Breast Cancer Treatment Information for Older Women.

Journal Article Ann Surg Oncol · February 2021 BACKGROUND: For women older than 70 years with early-stage breast cancer, the routine use of sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy offers no overall survival benefit and may be perceived as undesirable by many women. National guidelin ... Full text Link to item Cite

Medical Maximizing-Minimizing Preferences in Relation to Low-Value Services for Older Women with Hormone Receptor-Positive Breast Cancer: A Qualitative Study.

Journal Article Ann Surg Oncol · February 2021 BACKGROUND: Multiple studies have demonstrated the safety of omitting therapies in older women with breast cancer. Despite de-implementation guidelines, up to 65% of older women continue to receive one or more of these low-value services. Previous work has ... Full text Link to item Cite

Trends in Breast Cancer Treatment De-Implementation in Older Patients with Hormone Receptor-Positive Breast Cancer: A Mixed Methods Study.

Journal Article Ann Surg Oncol · February 2021 INTRODUCTION: Guidelines allow for the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women ≥ 70 years of age with hormone receptor-positive (HR +) breast cancer. Despite this, national data suggest these procedures have ... Full text Link to item Cite

Identification of promotion and prevention associated surgeon behaviors in the operating room to facilitate resident self-regulated learning.

Journal Article Am J Surg · February 2021 BACKGROUND: The regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establish ... Full text Link to item Cite

A novel heat shock protein inhibitor KU757 with efficacy in lenvatinib-resistant follicular thyroid cancer cells overcomes up-regulated glycolysis in drug-resistant cells in vitro.

Conference Surgery · January 2021 BACKGROUND: Patients with advanced differentiated thyroid cancer develop resistance to lenvatinib treatment from metabolic dysregulation. Heat shock protein 90 is a molecular chaperone that plays an important role in glycolysis and metabolic pathway regula ... Full text Link to item Cite

Patient Perspectives on Treatment Options for Older Women With Hormone Receptor-Positive Breast Cancer: A Qualitative Study.

Journal Article JAMA Netw Open · September 1, 2020 IMPORTANCE: Women aged 70 years or older with hormone receptor-positive breast cancer have an excellent prognosis, but because of their age and comorbidities, they are at higher risk for treatment-related adverse events. Despite studies demonstrating the s ... Full text Link to item Cite

Scope and Characteristics of Choosing Wisely in Cancer Care Recommendations by Professional Societies.

Journal Article JAMA Oncol · September 1, 2020 This quality improvement study describes the cancer types, treatments, and services often targeted in the recommendations generated by oncology societies for the Choosing Wisely campaign. ... Full text Link to item Cite

Novel C-terminal heat shock protein 90 inhibitors target breast cancer stem cells and block migration, self-renewal, and epithelial-mesenchymal transition.

Journal Article Mol Oncol · September 2020 In patients with triple-negative breast cancer (TNBC), evidence suggests that tumor-initiating cells (TIC) have stem cell-like properties, leading to invasion and metastasis. HSP90 plays a critical role in the conformational maintenance of many client prot ... Full text Link to item Cite

Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery: A Systematic Review.

Journal Article JAMA Surg · August 1, 2020 IMPORTANCE: Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value: (1) ax ... Full text Link to item Cite

A novel heat shock protein 90 inhibitor potently targets adrenocortical carcinoma tumor suppression.

Conference Surgery · January 2020 INTRODUCTION: Adrenocortical carcinoma is an aggressive cancer with a poor prognosis. Long noncoding RNAs are differentially expressed in cancer patients and contribute to cellular homeostasis, survival, and metastasis. We hypothesize that our novel C-term ... Full text Link to item Cite

Improved durable responses regardless of age following cytoreduction and "no-tourniquet" hyperthermic isolated limb chemotherapy for in transit melanoma of the extremity.

Journal Article Am J Surg · December 2019 BACKGROUND: In-transit metastatic melanoma of the extremity is a clinically aggressive disease. For patients with disease confined to the limb, regional chemotherapy remains an effective option. However, no studies thus far have included cytoreduction or p ... Full text Link to item Cite

Mimetic sHDL nanoparticles: A novel drug-delivery strategy to target triple-negative breast cancer.

Conference Surgery · December 2019 BACKGROUND: Withanolides are naturally derived heat shock protein 90 inhibitors that are potent in preclinical models of triple negative breast cancers. Conjugation to synthetic high-density lipoprotein nanoparticles improves solubility and targets deliver ... Full text Link to item Cite

BRAF and MEK Inhibitors: Use and Resistance in BRAF-Mutated Cancers.

Journal Article Drugs · April 2018 The mitogen activated protein kinase/extracellular signal-related kinase (MAPK/ERK) signaling pathway serves an integral role in growth, proliferation, differentiation, migration, and survival of all mammalian cells. Aberrant signaling of this pathway is o ... Full text Link to item Cite

Small-molecule inhibitor sorafenib regulates immunoreactions by inducing survival and differentiation of bone marrow cells.

Journal Article Innate Immun · October 2016 Sorafenib has been used for the treatment of liver cancer. However, its clinical impact on human immunity system remains poorly known. Our previous study has shown that sorafenib modulates immunosuppressive cell populations in murine liver cancer models. H ... Full text Link to item Cite

OPA1 downregulation is involved in sorafenib-induced apoptosis in hepatocellular carcinoma.

Journal Article Lab Invest · January 2013 Sorafenib has been used to treat advanced hepatocellular carcinoma (HCC), but the underlying molecular mechanisms remain controversial and why some patients do not respond to this therapy is poorly understood. In this study, we show that sorafenib triggers ... Full text Link to item Cite

Cyclooxygenase-2 and Akt mediate multiple growth-factor-induced epithelial-mesenchymal transition in human hepatocellular carcinoma.

Journal Article J Gastroenterol Hepatol · March 2012 BACKGROUND AND AIM: Cancer invasion and metastasis are characterized by epithelial-mesenchymal transition (EMT). Hepatocellular carcinoma (HCC) causes metastasis and significant mortality. Elucidating factors promoting EMT in HCC are necessary to develop e ... Full text Link to item Cite

Role of bile salt in regulating Mcl-1 phosphorylation and chemoresistance in hepatocellular carcinoma cells.

Journal Article Mol Cancer · April 20, 2011 BACKGROUND: Glycochenodeoxycholate (GCDA) is one of the major human bile salts. Bile salts stimulate cell survival and proliferation through the mitogen-activated protein kinase, but the downstream signaling mechanism(s) remains enigmatic. Mcl-1 is an anti ... Full text Link to item Cite

Nicotine enhances the antiapoptotic function of Mcl-1 through phosphorylation.

Journal Article Mol Cancer Res · December 2009 Lung cancer has a strong etiologic association with cigarette smoking. Nicotine, a major component in tobacco smoke, functions as a survival agonist that inhibits apoptosis following various stresses. However, the mechanism of action remains elusive. Mcl-1 ... Full text Link to item Cite

A nonhomologous end-joining pathway is required for protein phosphatase 2A promotion of DNA double-strand break repair.

Journal Article Neoplasia · October 2009 Protein phosphatase 2A (PP2A) functions as a potent tumor suppressor, but its mechanism(s) remains enigmatic. Specific disruption of PP2A by either expression of SV40 small tumor antigen or depletion of endogenous PP2A/C by RNA interference inhibits Ku DNA ... Full text Link to item Cite