Racial Disparities in Sentinel Lymph Node Biopsy in Women With Breast Cancer
A study by Black et al from The University of Texas MD Anderson Cancer Center, Houston, found that the use of sentinel lymph node biopsy to stage early breast cancer increased in both black and white women from 2002 to 2007, but the rates remained lower in black than white patients, a disparity that contributed to disparities in the risk for lymphedema. Racial disparities exist in many aspects of breast cancer care, but their existence in the use of sentinel node biopsy had been uncharacterized until now. The study was published in JAMA Surgery.
Key Findings
Researchers identified cases of nonmetastatic, node-negative breast cancer in women 66 years of age or older from 2002 through 2007. Of the 31,274 women identified, 1,767 (5.6%) were black, 27,856 (89.1%) were white and 1,651 (5.3%) were of other or unknown race.
Sentinel lymph node biopsy was performed in 73.7% of white patients and 62.4% of black patients. While the use of sentinel node biopsy increased by year for both black and white patients, blacks were 12% less likely than whites throughout the study period to undergo sentinel node biopsy.
The researchers suggested that adoption of sentinel node biopsy in black patients lagged 2 to 3 years behind its adoption in white patients. The 5-year cumulative lymphedema risk was 8.2% in whites and 12.3% in blacks. They noted that socioeconomic and geographic factors were associated with lower sentinel node biopsy use including insurance coverage through Medicaid, living in areas with lower education or income levels, and living in areas with fewer surgeons.
“These findings emphasize that not all newly developed techniques in breast cancer care are made available in a timely fashion to all eligible patients,” the investigators concluded. “As new techniques continue to be developed, focused educational interventions must be developed to ensure that these techniques reach historically disadvantaged patients to avoid disparities in care. More contemporary data will be needed to determine whether this disparity still exists in black patients and other at-risk minorities.”
Dalliah M. Black, MD, of the University of Texas MD Anderson Cancer Center, is the corresponding author for the study.
Study Implications
In an accompanying commentary, Colleen D. Murphy, MD, and Richard D. Schulick, MD, MBA, of the University of Colorado, Aurora, wrote, “One key and uncertain issue in the study of lymphedema is its very diagnosis.”
They continued, “In the study by Black and colleagues, it seems likely that patients undergoing axillary lymph node dissection, when sentinel node biopsy may have been indicated, were cared for at institutions without lymphedema screening protocols.… In black women, lymphedema screening may be especially relevant; Black et al have demonstrated that this population is at highest risk,” the authors noted.
“Black and colleagues have highlighted another disparity in breast cancer care and its associated morbidity. With this information in hand, we should seek to eliminate these differences as much as possible,” they added.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
