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Disparity Seen in Promising Staging Tool
By Marilynn Larkin
The use of sentinel lymph node biopsy (SLNB) to stage newly diagnosed breast cancer has been increasing. But minorities, older women and those from poorer areas are less likely to get the procedure, according to research published in the April issue of the Journal of the National Cancer Institute. “It’s hard to know why we see these disparities,” says Amy Y. Chen, MD, MPH, a director in the American Cancer Society’s Health Services Research division. “Most likely it’s because of insurance issues or lack of access to technology or women’s lack of awareness about the procedure.”
In SLNB, which is performed only during lumpectomy procedures, the surgeon removes up to three “sentinel” nodes in the armpit to determine whether cancer has spread beyond the breast. The newer technique is an alternative to the traditional, more invasive axillary lymph node dissection, which involves removing all the lymph nodes in the armpit.
Chen and her colleagues studied the use of SLNB versus axillary dissection using a database that includes 491,000 women who underwent lymph node sampling between 1998 and 2005. All of them were good candidates for SLNB, so the stage of their disease was not an issue. Although the use of the procedure increased from 26.8 percent to 65.5 percent during that time, the odds of getting it were lower for blacks, Hispanics and other minorities than for whites; they were also lower for women older than 72 years compared with those younger than 51. Living in a low-income neighborhood also meant a woman was less likely to get SLNB.
Based on the data, it’s hard to tell what’s behind the disparity, Chen reiterates. In some cases the communities where minority or uninsured women live may not have a hospital that provides sentinel node biopsies. Older or rural women may also consider mastectomy preferable to the six-week regimen of lumpectomy and radiation. Still, she adds, this signals the need for more widespread patient education.
