MedicalResearch: What are the main findings of the study?
Dr. Black: This is a retrospective study from 2002 – 2007 using the SEER/Medicare database of over 31,000 women with node negative breast cancer evaluating the utilization of sentinel node biopsy (SNB) as it transitioned from an optional method for axillary staging to the standard of care instead of complete axillary lymph node dissection (ALND). We found that SNB use increased each year in both white and black breast cancer patients throughout the study period. However, SNB was less often performed in black patients (62.4%)compared to white patients (73.7%) and this disparity persisted through 2007 with a 12% difference. Appropriate black patients more often had an ALND instead of the minimally invasive sentinel node biopsy which resulted in worse patient outcomes with higher lymphedema rates in black patients. However, when black patients received the minimally invasive SNB, their rates of lymphedema were low and comparable to white patients who received SNB.
MedicalResearch: Were any of the findings unexpected?
Dr. Black: Yes, the findings were unexpected. We did not expect to see a persistent racial difference in sentinel node biopsy use to as recent as 2007. We also did not expect to find that a disparity in the surgical treatment of breast cancer could negatively affect patient outcomes. This study highlights that even what surgeons do for the treatment of breast cancer can adversely impact a patient’s outcome.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Black: This study demonstrates the need for continued widely disseminated education to inform the medical community of practice changes and guidelines of care so that all patients benefit from improvements in breast cancer treatment. Patients should also seek out guidelines for cancer care so that they can advocate for themselves and become familiar with what is acceptable or standard practice in order to minimize worse outcomes. Luckily, there is a lot of good patient directed education information from reputable national groups that are accessible for most patients.
Also, we do not know why this disparity exists given that this is a retrospective database study. There are likely many factors that affect what type of care a patient receives including patient preference, the treating physicians, hospital type and location, and other socioeconomic factors.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Black: This study yields additional questions such as examining treatment decision making between the patient and healthcare team, understanding what factors determine why certain patients receive certain types of care, how national guideline practice changes are disseminated throughout our country to reach all physicians, and implementing programs to ensure that breast cancer patients receive the standard of care.
We also found a higher rate of lymphedema in black patients receiving ALND compared to white patients. Future research examining factors that may predispose black women to lymphedema will be helpful in creating ways to minimize this complication.
Examining surgical disparities in other disadvantaged and at risk patients of other ethnicities and low sociodemographics is also needed.
Black DM, Jiang J, Kuerer HM, Buchholz TA, Smith BD. Racial Disparities in Adoption of Axillary Sentinel Lymph Node Biopsy and Lymphedema Risk in Women With Breast Cancer. JAMA Surg. Published online June 18, 2014. doi:10.1001/jamasurg.2014.23.