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Disparity of Surgical Care in Patients with Early-Stage Breast Cancer

Awareness is the first step toward eliminating racial, ethnic, and socioeconomic factors in surgical treatment.

Sentinel lymph-node biopsy (SLNB) has become the accepted technique for evaluating lymph-node metastases in clinically node-negative breast cancer. To determine whether SLNB techniques were used impartially across patient subgroups, investigators evaluated information from the National Cancer Database on nearly 500,000 women who were treated for stage I or II breast cancer in the U.S. from 1998 to 2005 and who were candidates for SLNB.

Overall, 52.8% of patients received SLNB initially. Rates of SLNB versus axillary dissection increased from 27% in 1998 to 65% in 2005. Factors associated with lower likelihood of receiving SLNB were belonging to a racial or ethnic minority group (odds ratio for blacks vs. whites, 0.76), having no health insurance (OR, 0.77), having income below the national median (OR, 0.79), being older (OR for 72, 0.80), having government-sponsored health insurance (OR for Medicaid, 0.81), receiving care at a nonresearch or nonteaching hospital facility (OR for community hospital, 0.84), and having less education (OR for < high school diploma, 0.88).

Comment: Although long-term survival and recurrence data still are being collected from U.S. national SLNB clinical trials, the technique is accurate and safe for detecting breast cancer nodal metastases. SLNB also confers less overall morbidity (e.g., less hypoesthesia and paresthesia, less pain, less chance of lymphedema) than does standard axillary lymph-node dissection, with a more rapid return to normal quality of life. That some U.S. women do not receive less-invasive SLNB surgery, based on their socioeconomic status, race, or ethnicity, is unacceptable. The causes of these disparities are complex and multifactorial but correctable. This study also illustrates the importance of maintaining a National Cancer Database to detect critical — but sometimes subtle — inequities in cancer care delivery.

— Henry Mark Kuerer, MD, PhD, FACS

Published in Journal Watch Oncology and Hematology April 15, 2008

Citation(s):

Chen AY et al. Disparities and trends in sentinel node biopsy among early-stage breast cancer patients (1998–2005). J Natl Cancer Inst 2008 Apr 2; 100:462.

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