Expert Point of View: Elizabeth Mittendorf, MD

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“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 conducted through 2007, and even at that time there were hospitals in many areas of the United States that may not have had the necessary resources for sentinel lymph node biopsy, she continued. “It will be interesting to see the data from 2007 to 2009, which will be available soon, to see if we have closed this gap,” she said.

Necessary Resources

Nuclear physicists, tracers (colloid and blue dye), and the gamma probe are resources needed to perform sentinel lymph node biopsy. “I would like to think that these resources are now more widely available. I think the disparity in care may be driven more by geography and access to these resources than race. Most larger centers are now routinely performing [sentinel lymph node biopsy] in blacks and whites,” she stated. “My hypothesis is that hospitals in certain geographic areas were without the necessary resources during the period evaluated, but the disparity is probably due to a confluence of factors,” she speculated.

“For me, the most interesting part of the study was the difference in rates of lymphedema between blacks and whites undergoing [axillary lymph node dissection]. We can’t tease out the contributing factors from the data that were presented. The extent of surgery is obviously a factor, but there are other factors as well. There is a need for genomic studies to identify factors that may be modifiable,” Dr. Mittendorf stated. ■

Disclosure: Dr. Mittendorf reported no potential conflicts of interest.

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