Disparities of Management of the Axilla in Women With Clinically Node Negative Breast Cancer. J Surg Res 2020 Dec;256:13-22
Date
07/18/2020Pubmed ID
32679224Pubmed Central ID
PMC8353960DOI
10.1016/j.jss.2020.05.100Scopus ID
2-s2.0-85087820385 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: In women with clinically node-negative breast cancer, sentinel lymph node biopsy is the first step in axillary staging. A randomized trial published in 2013 concluded that patients with sentinel lymph node micrometastases (N1mi) do not benefit from axillary lymph node dissection (ALND). We hypothesized that disparities exist in management of the axilla in node-negative patients.
METHODS: We included women aged >40 years with nonmetastatic, clinically node-negative breast cancer from 2014 to 2016 in the National Cancer Database. Women treated neoadjuvantly, with large tumors (cT4), or no tumor (cT0) were excluded. Multivariable logistic regression identified patient and facility characteristics associated with undergoing ALND as first axillary surgery and completion ALND in the setting of N1mi disease.
RESULTS: Of 273,951 patients, 22,898 (8%) underwent ALND first. These patients were more likely to be Hispanic (OR: 1.21, 95% CI: 1.10, 1.32), have Medicare (OR: 1.13, 95% CI: 1.03, 1.24), be uninsured (OR: 1.28, 95% CI: 1.08, 1.53), have lower educational attainment (OR: 1.24, 95% CI: 1.17, 1.32), be treated at a community hospital (OR: 1.62, 95% CI: 1.52, 1.74), or reside in the South (OR: 1.19, 95% CI: 1.12, 1.26). In the sentinel lymph node biopsy first group, 8,882 (4%) were classified as N1mi and 1,872 (21%) underwent subsequent ALND. These patients were more likely to be Hispanic (OR: 1.70, 95% CI: 1.19, 2.42) and have the lowest income (OR: 1.62, 95% CI: 1.15, 2.27).
CONCLUSION: Disparities persist in implementation of evidence-based management of the axilla in women with clinically node-negative breast cancer.
Author List
Aubry S, Strassle PD, Maduekwe U, Downs-Canner SAuthor
Ugwuji N. Maduekwe MD Associate Dean, Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Axilla
Breast Neoplasms
Evidence-Based Medicine
Female
Guideline Adherence
Healthcare Disparities
Humans
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Neoplasm Micrometastasis
Neoplasm Staging
Practice Guidelines as Topic
Retrospective Studies
Sentinel Lymph Node
Sentinel Lymph Node Biopsy
Socioeconomic Factors
United States
