This article is more than 5 years old. Information may no longer be current.
Black women less likely to undergo SLNB for breast cancer
Although the use of sentinel lymph node biopsy increased steadily over time among black women with node-negative breast cancer, they continue to undergo the procedure at a significantly lower rate than white women, according to results of a retrospective study.
The disparity in sentinel lymph node biopsy (SLNB) use also correlated with an increased risk for lymphedema among black women, results showed.
Dalliah M. Black
Dalliah M. Black, MD, FACS, assistant professor in the department of surgical oncology at The University of Texas MD Anderson Cancer Center, and colleagues reviewed the SEER-Medicare linked database from 2002 through 2007 to identify women aged 66 years and older with incident, nonmetastatic, node-negative breast cancer.
The analysis included 31,274 women, of whom 89.1% were non-Hispanic white, 5.6% were black, and 5.3% were of other or unknown race.
During the entire study period, 73.7% of non-Hispanic white women and 62.4% of black women underwent SLNB (P˂.001). Adjusted analyses indicated black women were significantly less likely to undergo the procedure (OR=0.67; 95% CI, 0.6-0.75).
Use of SLNB increased during the study period among both non-Hispanic white women (58.1% in 2002 to 85.4% in 2007) and black women (45.4% in 2002 to 73.1% in 2007). However, researchers observed “a fixed disparity” in SLNB use of about 12 percentage points between white women and black women, and the difference in SLNB rates between groups remained statistically significant each year.
Black and colleagues also found lymphedema incidence was higher overall among black women compared with white women (12.3% vs. 8.2%; HR=1.43; 95% CI, 1.23-1.67).
Among women who underwent SLNB, the 5-year lymphedema risk was higher among blacks than whites (8.8% vs. 6.8%; HR=1.28; 95% CI, 1.02-1.6).
Use of axillary lymph node dissection also was associated with increased 5-year lymphedema risk among both blacks (HR=2.76; 95% CI, 2.25-3.59) and whites (12.2%; HR=1.79; 95% CI, 1.63-1.96).
The difference in lymphedema incidence and risk draws attention to one more racial disparity in breast cancer, Colleen D. Murphy, MD, and Richard D. Schulick, MD, MBA, both of the department of surgery at University of Colorado, wrote in an accompanying editorial.
“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,” Murphy and Schulick wrote. “As such, the number of patients with clinically relevant lymphedema in the study population is likely higher than what was indicated by diagnostic codes. Screening for lymphedema in patients with breast cancer is important because early detection allows for early intervention, thereby minimizing patient morbidity and health care costs. In black women, lymphedema screening may be especially relevant; Black et al have demonstrated that this population might be at highest risk.”
For more information:
-
Black DM. JAMA Surg. 2014;doi:10.1001/jamasurg.2014.23.
-
Murphy CD. JAMA Surg. 2014;doi:10.1001/jamasurg.2014.44.
Disclosure: The researchers report no relevant financial disclosures. Murphy and Schulick report no relevant financial disclosures.
Perspective
Back to Top
This study by Black and colleagues continues the trend of identifying further racial disparities in breast cancer care. Their retrospective study of the SEER Medicare database from 2002 through 2007 revealed that the rates of sentinel lymph node biopsy remained 12% lower among black patients than white patients. The failure to appropriately adopt this recommended therapy possibly led to increased rates of lymphedema among black patients with breast cancer.
The results of the study are not at all surprising, as they are consistent with prior reports in the literature that showed racial disparities in the use of sentinel lymph node biopsy (Chen AY. J Natl Cancer Inst. 2008;100:462-474; Maggard MA. Ann Surg Oncol. 2005;12:41-47). This report is particularly interesting, however, because it points out an important consequence of the failure to perform optimal care — that is, the development of lymphedema. Lymphedema can be a disabling complication of breast cancer treatment, leading to increased risk of infection, as well as decreased mobility and use of an upper extremity. That black women with breast cancer could be disproportionately suffering from lymphedema due to suboptimal breast cancer care is particularly troubling.
However, it is important to note — although this study does add to a large body of literature documenting racial disparities in breast cancer care — I would argue that the oncology community does not need many more of these studies. What we urgently need are research studies that provide effective interventions to reduce disparities in cancer care. We need to fund and prioritize more studies that provide culturally appropriate and tailored approaches to improve the quality of cancer care among all populations but, in particular, our most vulnerable patients.
References:
Alderman AK. Abstract #6510. Presented at: ASCO Annual Meeting; May 30-June 3, 2008; Chicago.
Elledge RM. J Natl Cancer Inst. 1994;86:705-712.
Elmore JG. Med Care. 2005;43:141-148.
Franzini L. Ann Surg Oncol. 1997;4:111-118.
Goel MS. J Gen Intern Med. 2005;20:604-611.
Griggs JJ. Breast Cancer Res Treat. 2003;81:21-31.
Howard DL. Fam Med. 1998;30:228-235.
Joslyn SA. Cancer. 2000;88:114-123.
Joslyn SA. Cancer 2002;95:1759-1766.
Lyman GH. Ann Surg Oncol. 1997;4:80-87.
Morris CR. Am J Public Health. 2000;90:281-284.
Nattinger AB. N Engl J Med. 1992;326:1102-1107.
Newman LA. Cancer. 2003;97 (1 Suppl):246-252.
Ries LA. SEER Cancer Statistics review, 1975-2003. Available at: http://seer.cancer.gov/csr/1975_2003. Accessed on June 29, 2014.
Surveillance Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence — SEER 17 Regs Public Use, Nov 2005 Sub (1973-2003 varying). 2006. NCI, Surveillance Research Program, Cancer Statistics Branch.
Tseng JF. Cancer. 2004;101:1514-1523.
Walker B. Environ Health Perspect. 1995;103(Suppl 8):275-281.
Yood MU. J Natl Cancer Inst. 1999;91:1487-1491.