Purpose: Investigate incidence of axillary lymph node metastases in early breast cancer in women >74 years Australia and New Zealand and identify predictors for lymph node positivity in each age group with the aim of reviewing likelihood of sentinel lymph node (SLN) positivity in early breast cancer in patients >74 years to assist clinician decision making when considering SLN biopsy in this population. Methodology: Retrospective review of invasive breast cancer in females in Australia and New Zealand between 2010-2022 using BreastSurgANZ Quality Audit Database. Data included patient demographics, tumour type, surgery type, neoadjuvant and adjuvant therapies. Descriptive and exploratory analyss of incidence of axillary lymph node metastases in various patient and tumour groups, followed by univariate logistic regression to identify predictors of SLN positivity, p value < 0.05 considered significant. Results: Review of 127,436 cases of invasive breast cancer, of which 17,599 were >74 years. Two thirds (66%) of the overall population and in those >74 years were node negative. In patients >74 years with T1a-b cancers 91% were node negative. In patients >74 years with grade 1-2, T1a-b cancers, ER+/HER2- without lymphovascular invasion, 94% were node negative. Tumour size, grade and biomarker profile correlated with axillary lymph node status (p<0.05). Conclusion: More than 90% patients in BQA dataset with early breast cancer and favourable features (Grade 1-2, T1a-b, ER+/HER2- and no lymphovascular invasion) were node negative. Therefore, routine surgical axillary nodal staging in this group of patients needs to be reconsidered.