Less Frequent Use of Sentinel Lymph Node Biopsy and Higher Risk of Lymphedema in Black Women With Breast Cancer in Medicare Population
In a retrospective study reported in JAMA Surgery, Black et al found that the sentinel lymph node biopsy rate was lower and risk for lymphedema higher in black vs white women with early-stage breast cancer in the Medicare population.
Study Details
The study used the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database from 2002 through 2007—a period when sentinel lymph node biopsy became the preferred method for axillary staging—to identify cases of incident nonmetastatic, pathologically node-negative breast cancer in women aged ≥ 66 years.
Among the 31,274 women identified, median age was 77 years, 1,767 (5.6%) were black, 27,856 (89.1%) were white, and 1,651 (5.3%) were of other/unknown race, and 72.6% underwent sentinel lymph node biopsy and 27.4% underwent axillary lymph node biopsy. Black patients were more likely than white patients to have moderate to severe comorbidity (24.7% vs 11.3%, P < .001) and larger tumors (median tumor size = 1.5 vs 1.3 cm, P < .001).
Sentinel Lymph Node Biopsy Rates
Overall, sentinel lymph node biopsy was performed in 73.7% of white patients vs 62.4% of black patients (P < .001). The use of sentinel lymph node biopsy increased by year for both black (45.4% to 73.1% over study period) and white patients (58.1% to 85.4%), with an absolute disparity of approximately 12% persisting over time. In adjusted analysis, black patients were significantly less likely to undergo sentinel lymph node biopsy (odds ratio [OR] = 0.67, P < .001).
Lymphedema Risk
Overall, the cumulative 5-year risk of lymphedema was 8.2% in whites vs 12.3% in blacks (hazard ratio [HR] = 1.43, P < .001), including 6.8% vs 8.8% in those undergoing sentinel lymph node biopsy (HR = 1.28, P = .03) and 12.2% in whites undergoing axillary lymph node biopsy (HR =1.79, P < .001, vs whites undergoing sentinel lymph node biopsy) vs 18.0% in blacks undergoing axillary lymph node biopsy (HR = 2.76, P < .001, vs whites undergoing sentinel lymph node biopsy).
The investigators concluded: “Although sentinel lymph node biopsy use increased in both black and white patients with pathologically node-negative breast cancer from 2002 through 2007, the rates of sentinel lymph node biopsy remained lower in black than white patients during this entire period by approximately 12 percentage points. This racial disparity in sentinel lymph node biopsy use contributed to racial disparities in lymphedema risk. Improvements in the dissemination of new techniques are needed to avoid disparities in breast cancer care and patient outcomes, particularly in disadvantaged groups.”
Dalliah M. Black, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Surgery article.
The authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
