Annals of Surgical Oncology

, Volume 16, Issue 3, pp 562–570

Disparities in Receipt of Lymph Node Biopsy Among Early-Stage Female Breast Cancer Patients

  • Michael T. Halpern
  • Amy Y. Chen
  • Nicole S. Marlow
  • Elizabeth Ward
Healthcare Policy and Outcomes

DOI: 10.1245/s10434-008-0205-7

Cite this article as:
Halpern, M.T., Chen, A.Y., Marlow, N.S. et al. Ann Surg Oncol (2009) 16: 562. doi:10.1245/s10434-008-0205-7

Abstract

Accurate staging of early breast cancer requires pathological assessment of axillary lymph node involvement. We evaluated the proportion of women receiving surgery for early-stage breast cancer who do not receive any lymph node biopsy (LNB) and factors associated with not receiving LNB. Patients receiving surgery for early-stage breast cancer (T1a/T1b/T1c/T2N0) during the period 2003–2005 were selected from the National Cancer Database. Patient sociodemographic, clinical, health insurance, and facility information was collected. Logistic regression was used to assess factors predictive of not receiving LNB. The number of women meeting study inclusion criteria was 184,050, 11% of whom did not receive any LNB. Compared with White patients, Black patients had greater likelihood [odds ratio (OR) 1.10, p < 0.001] of receiving no LNB; there were no significant differences for Hispanic or other non-White patients. Individuals who were uninsured (OR 1.24, p < 0.0005) or covered by Medicare at age <65 years (OR 1.29, p < 0.0001) had greater likelihoods of no LNB compared with those with private insurance. Medicaid patients and Medicare patients ≥65 years were not significantly different from private insurance patients. Compared with the youngest quartile of patients (age ≤51 years), patients in the oldest quartile (age ≥73 years) were more than three times as likely (OR 3.30, p < 0.0001) not to receive any LNB. We conclude that, while guidelines indicate that LNB may be considered optional in certain patient groups, it remains a key component in determining stage, and thereby prognosis and appropriate treatment options. These results indicate that significant disparities exist in sampling of axillary lymph nodes among women with early-stage breast cancer.

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Michael T. Halpern
    • 1
  • Amy Y. Chen
    • 2
    • 3
  • Nicole S. Marlow
    • 4
  • Elizabeth Ward
    • 2
  1. 1.Division of Health Services and Social Policy ResearchRTI InternationalWashingtonUSA
  2. 2.Department of Health Services ResearchAmerican Cancer SocietyAtlantaUSA
  3. 3.Department of OtolaryngologyEmory UniversityAtlantaUSA
  4. 4.Department of Biostatistics, Bioinformatics and EpidemiologyMedical University of South CarolinaCharlestonUSA