An analysis of data collected in the Surveillance, Epidemiology and End Results (SEER)-Medicare database between 2002 and 2007 shows that though newer, less invasive breast cancer staging procedures have become standard, African-American women were 12 percent less likely to have the less invasive surgery than their white peers.
The research points to a continuing area of concern about racial disparities in breast cancer care. An updated analysis of data from 2010 to present is planned. This study was reported at the 2012 San Antonio Breast Cancer Symposium.
In axillary lymph node dissection, a large number of lymph nodes in the armpit are surgically removed and analyzed to help determine the stage of breast cancer. Lymph nodes help filter certain fluids in the body and store white blood cells; axillary lymph nodes are those found in the armpit. When breast cancer travels, it often goes to the axillary lymph nodes first.
Axillary lymph node dissection has been linked to short- and long-term side effects, such as lymphedema, swelling of the arm, armpit, or area of the chest near the armpit. Lymphedema happens when lymph, the fluid lymph nodes filter, collects under the skin. It is a lifelong side effect that must be managed with ongoing treatment.
A newer alternative to axillary lymph node dissection is sentinel lymph node biopsy, a surgery in which only one or two lymph nodes – the sentinel nodes – are removed. The sentinel nodes are the first lymph nodes likely to test positive for cancer. Whether the sentinel nodes test positive helps doctors determine the cancer stage. Sentinel lymph node biopsy is less likely than axillary dissection to cause lymphedema.
The researchers explored whether differences exist in which surgery is used to stage breast cancer in African-American versus white women. Sentinel lymph node biopsy is now the standard of care.
Study Structure and Findings
The study analyzed data from 31,274 women over age 65 diagnosed with early-stage breast cancer. Of the total, 1,767 were African-American, 27,856 where white, and 1,651 were of another or unknown race. The results showed:
- The less-invasive sentinel node biopsy was performed in 74 percent of white women and only 62 percent of African-American women
- This disparity persisted through 2007, even after accounting for more doctors performing sentinel lymph node biopsy over time
- Over the five years studied, 11.4 percent of women who had the more-invasive axillary node dissection developed lymphedema, versus 6.3 percent of women who had sentinel node biopsy
- Overall, African-American women were more likely to develop lymphedema
- Women of both races who had sentinel node biopsy had an equal chance of developing lymphedema
It is important to note that newer techniques tend to be slower to reach county hospitals that traditionally treat larger, more diverse groups than those that may have been included in this study. This slow progression of care standards is sometimes due to higher costs and the need for cooperation among medical departments or doctors trained to perform the new treatment.
What This Means For You
This analysis suggests that even as new standards of care develop, some groups benefit more than others. The researchers suggest that broader implementation of changes in treatment standards, team approaches to cancer care and education about surgical options may help.
Talk with your doctor about the kind of lymph node surgery recommended, as well as its side effects. If you aren’t sure why your surgeon recommends a surgery, it is OK to ask why. For a list of common questions about lymph node surgery, download our Guide to Understanding Treatment Decisions.
If you have trouble finding information about breast cancer, talk with any of your healthcare providers about resources that may exist in your area or see LBBC’s resources for African-American women for more information. You may also call our Survivors’ Helpline at (888) 753-LBBC (5222) for information and peer support.
Note: LBBC will link to the abstract when it becomes publicly available.