SABCS: African American Women Less Likely to Receive Sentinel Lymph Node Biopsy

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(ChemotherapyAdvisor) – Minimally invasive sentinel lymph node biopsy (SLNB) has been standard practice for breast cancer staging for a decade, but African American women remain significantly less likely than white women to receive it – a disparity associated with elevated levels of lymphedema among African American patients, according to a study reported during the 2012 CTRC-AACR San Antonio Breast Cancer Symposium (SABCS).

The findings illustrate “the need for continued improvements in disseminating national practice guidelines for breast cancer to surgeons and other breast cancer providers in all of our communities,” reported lead author Delliah Mashon Black, MD, assistant professor of surgery in the Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center in Houston, TX.

Dr. Black's team analyzed data for 31,274 women 66 years old and older from the US National Cancer Institute (NCI)'s Surveillance, Epidemiology and End Results (SEER) and Medicare billing databases to explore patterns of care for women diagnosed with non-metastatic, node-negative breast cancer at age ≥66 years, they reported.

Between 2002 and 2007, “SLNB was performed in 74% of white patients compared to 62% of black patients (P<0.001)” overall, Dr. Black reported. After statistically controlling for clinicopathologic factors, “black patients were 33% less likely than white patients to undergo SLNB (relative risk [RR] 0.74, 95% CI, 0.67-0.81; P<0.001),” she said.

SLNB rates increased each year between 2002 and 2007 (P<0.001) for both black and white patients, but “a fixed disparity in the use of SLNB persisted through 2007,” Dr. Black noted.

“The fact that this disparity continued over time shows that new and improved surgical therapies may not be effectively implemented in some patient populations,” she saidindicated.

SLN was introduced as an alternative to the more invasive axillary lymph node dissection (ALND) in the mid-1990s, Dr. Black noted. ALND is effective but involves higher complication rates than SLNB.

Lymphedema rates were 11.4% (5-year cumulative incidence) among patients who underwent ALND, compared to 6.3% for patients who underwent SLNB (HR 1.92, 95% CI, 1.75-2.10; P<0.001), Dr. Black found. African American women had higher rates of lymphedema overall; however, in instances when they underwent SLNB instead of ALNB, the disparity in the risk of lymphedema disappeared (6.2% [white patients] and 7.7% [black patients]; P=0.08), she noted.

“When we think of disparities, it doesn't only mean that patients might be undertreated, but that they could be overtreated with unnecessary and more radical procedures, leading to a higher risk of complications, as shown in this study,” Dr. Black emphasized.

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