The researchers found that 62 percent of African American patients underwent the SLN biopsy, compared to 74 percent of the Caucasian patients. Although the SLN biopsy rate increased in both groups between 2002 and 2007, a fixed disparity persisted through the five years.
The five-year cumulative incidence of lymphedema was 12.2 percent in those who received ALN dissection, compared to 6.8 percent in those who received SLN biopsy. Overall, African Americans had a higher rate of the complication with 18 percent having lymphedema after axillary node dissection; however, among those patients who had the SLN biopsy, patients had similar risk of lymphedema, regardless of race.
"The risk of lymphedema was primarily driven by differences in treatment: ALN dissection resulted in about twice the risk. When we looked at outcomes stratified by treatment, Caucasians and African Americans had similar risks of lymphedema if they had a SLN," says Benjamin Smith, M.D., associate professor in MD Anderson's Department of Radiation Oncology and the study's senior author. "This ties the treatment disparity to a disparity in outcome."
Overall, the findings were a surprise to Black and her team.
"We were surprised to learn that the disparity persisted through 2007 and that there was an adverse patient outcome, lymphedema, associated with the findings. However, when we controlled for tumor characteristics and types of breast surgery, there was still a significant difference," says Black.
"SLN is a safe and integral part of the surgical management of early invasive breast cancer. Improving patient education and creating ways to ensure all healthcare providers know practice guidelines and are able to implement them will help with this disparity. Appropriate patients with early sta
|Contact: Laura Sussman|
University of Texas M. D. Anderson Cancer Center