Racial disparities in breast cancer care extends to lymph node biopsy

Racial disparities in breast cancer care extends to lymph node biopsy
Racial disparities in breast cancer care extends to lymph node biopsy

Sentinel lymph node biopsy (SLNB) is used for staging early breast cancer. The procedure was developed to replace axillary lymph node dissection (ALND), minimizing complications as SLNB often entails a much more limited surgery. However, a study from the University of Texas MD Anderson Cancer Center, in Houston, reveals a disparity in use of SLNB between black and white women.

Despite an increase in the use of SLNB in both black and white women from 2002 to 2007, black women were 12% less likely to undergo the procedure than white women. This disparity was also associated with disparities in the risk for lymphedema.

To conduct the study, Dalliah M. Black, MD, and colleagues identified cases of nonmetastatic, node-negative breast cancer in women age 66 years and older from 2002 to 2007. The investigators identified a study population of 31,274 women (1,767 were black [5.6%], 27,856 were white [89.1%], and 1,651 were of other or unknown race [5.3%]). The study was published in JAMA Surgery (2014; doi:10.1001/jamasurg.2014.23)

The study found that SLNB was performed in 73.7% of white patients and 62.4% of black patients. The 5-year cumulative lymphedema risk was 8.2% in white patients and 12.3% in black patients. Socioeconomic and geographic factors associated with lower SLNB use included insurance coverage through Medicaid, living in areas with lower education or income levels, and living in areas with fewer surgeons. The authors suggest that adoption of SLNB in black patients lagged 2 to 3 years behind its adoption in white patients.

“These findings emphasize that not all newly developed techniques in breast cancer care are made available in a timely fashion to all eligible patients,” reported the investigators. “As new techniques continue to be developed, focused educational interventions must be developed to ensure that these techniques reach historically disadvantaged patients to avoid disparities in care.”

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