Black women and other racial minorities are less likely than white women to receive sentinel lymph node (SLN) dissection as the standard of care for clinically node-negative breast cancer, and this has negative consequences, an analysis of the Surveillance, Epidemiology and End Results (SEER)/Medicare database suggested.
Dalliah M. Black, MD, FACS, Assistant Professor of Surgical Oncology, M.D. Anderson Cancer Center, Houston, reported that the use of SLN surgery was approximately 12% to 14% less for black women who received treatment between 2002 and 2007, when this procedure became preferred over axillary lymph node completion.
The disparity was independent of patient age, tumor characteristics, type of cancer surgery, and other factors. Although as a retrospective analysis, the differences are not easy to explain, Dr Black believes that socioeconomic factors may play a role. Other breast cancer specialists agreed that race may be a surrogate for socioeconomic level, which has been shown to be associated with disparities in access to care.
The study examined 31,274 women in the SEER/Medicare database who were diagnosed with nonmetastatic, invasive breast cancer from 2002 through 2007. The overall rate of SLN dissection was 62% among black patients, 65% among other nonwhite patients, and 74% among white patients (P <.001 for all), Dr Black reported.
For both racial groups, the use of SLN surgery increased over the study period. By 2007, when the approach was recommended as preferred in the guidelines of the National Comprehensive Cancer Network, the rates were 70% for black women and 83% for white women, she added. This difference remained stable, regard-less of whether the women ultimately received a lumpectomy only or a mastectomy.
The disparity impacted negatively on the occurrence of lymphedema, Dr Black continued. At 5 years, the incidence of lymphedema was 18% among black women who underwent axillary dissection rather than SLN dissection, 12.2% among white women who underwent axillary dissection, 8.8% for black women who received SLN dissection, and 6.8% for white women who had SLN dissection.
Axillary dissection and black race were both independent predictors of an elevated risk of lymphedema (P <.001). The finding that lymphedema rates were equally low for black patients and for white patients who received SLN dissection “suggests that when black patients had the appropriate surgery, they were not at an increased risk of lymphedema,” she said.
