Although sentinel lymph node biopsy is the recommended method for axillary staging of node-negative breast cancer, racial disparities in access to care were found in a study presented at the 2012 San Antonio Breast Cancer Symposium. Black women were 12% less likely than white women with breast cancer to receive sentinel lymph node biopsy for axillary staging. Additionally, black women were twice as likely as white women to develop lymphedema when undergoing axillary lymph node dissection compared to patients having a sentinel node biopsy, the study found.
“These findings emphasize the need for continuing dissemination of national practice guidelines for breast cancer to surgeons and other breast cancer providers in our communities,” stated lead author Dalliah M. Black, MD, Assistant Professor at The University of Texas MD Anderson Cancer Center in Houston.
The study utilized data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to determine patterns of care—specifically, whether there was a difference in the utilization of sentinel lymph node biopsy in black patients compared with whites, and whether this difference had an influence on risk of lymphedema. The study sample was 31,274 women aged 66 or older; 1,767 were black, 27,856 were white, and 1,651 were “race unknown.”
Overall, sentinel lymph node biopsy was used in 62% of black women and 65% of other nonwhite patients, compared with 74% of white women (P < .001 for both comparisons). Although the rate of sentinel lymph node biopsy increased from 2002 to 2007, the magnitude of racial disparity was similar throughout this period. In an analysis adjusted for patient characteristics, tumor size, and type of surgery, blacks remained 33% less likely to undergo the procedure. By 2007, when sentinel lymph node biopsy was recommended in the National Comprehensive Cancer Network (NCCN) guidelines, it was performed in 83% of whites vs 70% of blacks. Sociodemographic factors such as a patient residing in lower-income or lower-education regions and residing in areas with fewer surgeons were associated with lower sentinel lymph node biopsy receipt.
The disparity in access to sentinel lymph node biopsy affected rates of lymphedema, Dr. Black continued. The 5-year cumulative incidence of lymphedema was 18% in black women and 12.2% in white women who underwent complete axillary lymph node dissection (P < .001). Among those who got sentinel lymph node biopsy, rates of lymphedema were not significantly different according to race: 8.8% for black women and 6.8% for white women.
The risk of lymphedema was in a similar range for blacks and whites who underwent sentinel lymph node biopsy, suggesting that when black patients are offered the appropriate surgery, they are not at greatly increased risk of lymphedema, Dr. Black said. Axillary lymph node dissection and black race were independent, significant predictors of risk of lymphedema (P < .001).
Dr. Black and colleagues plan to study the patterns of care from 2007 to 2009 to determine if access has improved for blacks. ■
Disclosure: Dr. Black reported no potential conflicts of interest.
1. Black DM, Jiang J, Kuerer HM, et al: Disparities in the utilization of axillary sentinel lymph node biopsy among black and white patients with node negative breast cancer from 2002-2007. 2012 San Antonio Breast Cancer Symposium. Abstract S2-3. Presented December 5, 2012.
“This study confirms previously published racial disparities in access to care, but factors that drive these disparities have not been elucidated,” stated Elizabeth Mittendorf, MD, Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center, Houston.
The study was...