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Black women less likely than whites to undergo sentinel lymph node biopsy
SAN ANTONIO — Black women with breast cancer were 12% less likely than white women with breast cancer to undergo sentinel lymph node biopsy, according to study results presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.
The cohort included 51,063 women from the SEER/Medicare database who had been diagnosed between 2002 and 2007.
“Eligible patients had node-negative disease,” said Dalliah Mashon Black, MD, assistant professor of surgery in the department of surgical oncology at The University of Texas MD Anderson Cancer Center. “The study cohort included 31,274 women with negative axillary lymph nodes on pathology, documented axillary procedure and no evidence of distant metastasis.”
Four percent of the study population was black.
The rate of sentinel lymph node biopsy was 74% in whites compared with 62% in blacks.
“The rate was significantly higher in white patients than blacks, with an absolute difference of 12%,” Black said.
The trend remained over time, from when the procedure was deemed an acceptable alternative in 2002, to when it was endorsed in 2005, through when it was the preferred strategy in 2007.
“The difference was 83% for whites vs. 70% for blacks by 2007,” Black said.
The 5-year lymphedema risk was 18% among black patients who had axillary lymph node dissection compared with 12.2% for whites who had the same procedure. When sentinel lymph node biopsy was performed, the lymphedema risk was 8.8% for blacks and 6.8% for whites.
“If black patients had the same surgery, their lymphedema risk would be the same,” Black said.
Sentinel lymph node biopsy increased in both black and white patients when it became preferred, Black said.
“Focused education on this procedure should be broadly instituted in minority populations so black patients can have the best clinical outcomes,” she said.
For more information:
Black DM. #S2-3. Presented at: the 2012 CTRC-AACR San Antonio Breast Cancer Symposium. Dec. 4-8, 2012. San Antonio, Tex.
Disclosure: Black reports no relevant financial disclosures.
Perspective
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This study is important in that it highlights the need for ongoing quality assessment within multidisciplinary breast cancer programs. Sentinel lymph node biopsy is the gold standard currently for assessing the axilla in patients with early-stage breast cancer. Sentinel node biopsy reduces the risk of lymphedema, and it is accurate and safe. Although it is encouraging that the rate of sentinel lymph node biopsy increased during the time of the study, the identification of subgroups of patients in whom sentinel node biopsy was less commonly performed suggests opportunities for quality improvement.
The study reports data through 2007 and does not provide data into the current time period, but it does highlight the need for continually looking at patterns of breast care among black women and other subgroups of patients. By understanding disparities such as the one highlighted in this study, we can begin to design specific interventions to improve care for all patients. Participation of breast centers in programs such as the National Accreditation Program for Breast Centers, which requires annual quality measurement, represents an important opportunity for breast cancer programs and patients. Ongoing quality assessment and reporting is essential to ensuring all patients have access to the highest current standards of practice for breast cancer.