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Influence of rurality on lymph node assessment among women diagnosed with ductal carcinoma in situ and treated with mastectomy, SEER 2000–2015

  • Epidemiology
  • Published:
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Abstract

Purpose

Despite recommendations from national organizations supporting the use of lymph node assessment (LNA) among patients with ductal carcinoma in situ (DCIS) at time of mastectomy, variation in practice patterns across the United States has been observed. However, few studies have evaluated LNA differences and rurality.

Methods

Data from the SEER Patterns of Care studies were used to identify women who underwent mastectomy for newly diagnosed DCIS during 2000, 2005, 2010, and 2015. Weighted multivariate logistic regression was used to evaluate the association between rural–urban residence and the use of LNA. A subgroup analysis was performed comparing the use of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB).

Results

Of the 504 patients included in the analysis, approximately 81% underwent LNA at time of mastectomy with lower rates of use observed among rural patients (66%) versus urban patients (82%). In multivariate analysis, LNA increased over time (p < 0.0001), and rural patients were less likely to receive LNA compared to urban patients [adjusted odds ratio (aOR) = 0.19; 95% confidence interval (CI) 0.06–0.66]. However, the likelihood of undergoing ALND relative to SLNB was lower among rural compared to urban patients (aOR = 0.16; 95% CI 0.03–0.73).

Conclusions

Over time, the use of LNA with mastectomy has increased among DCIS patients. However, significant rural–urban differences in the use and type of LNA persist. The findings of this study highlight the importance of continued research aimed at examining the impact of rurality on the receipt of high-quality cancer care.

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Data availability

Access to the Patterns of Care dataset can be requested here: https://healthcaredelivery.cancer.gov/poc/access.html.

Code availability

Available upon reasonable request and approval by the NCI.

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Acknowledgements

This study used data provided by the National Cancer Institute’s Patterns of Care studies. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Healthcare Delivery Research Program and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation these data. The authors would like to thank Dr. Michael Halpern of the NCI for providing access to the Patterns of Care data as well as Dr. Michele West, Bobbi Jo Matt, and Amanda Kahl of the State Health Registry of Iowa for providing responses to questions regarding the POC dataset.

Funding

Data collection at the University of Iowa was supported by NCI contract numbers N01-CN-05229, N01-PC-67008, N01-PC-35143, HHSN261201000032C, HHSN261201300020I and the Holden Comprehensive Cancer Center contract number P30 CA086862.

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Authors and Affiliations

  1. Department of Epidemiology, College of Public Health, University of Iowa, S475, Iowa City, IA, 52242, USA

    Danielle Riley, Elizabeth A. Chrischilles, Mary Charlton & Charles F. Lynch

  2. Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Ingrid M. Lizarraga

  3. Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA

    Brian J. Smith

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  1. Danielle Riley
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Contributions

Conceptualization: DR, CFL; Methodology: DR, BJS; Formal analysis: DR, BJS; Writing-original draft: DR; Writing-review and editing: DR, EAC, IML, BJS, CFL; Supervision: EAC, CFL.

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Correspondence to Danielle Riley.

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Waived by the Institutional Review Board of the University of Iowa due to the observational nature of the study design and use of de-identifiable data.

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The manuscript was submitted to the NCI POC contact and approved for publication. All authors have read the paper and consent to its publication.

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Riley, D., Chrischilles, E.A., Lizarraga, I.M. et al. Influence of rurality on lymph node assessment among women diagnosed with ductal carcinoma in situ and treated with mastectomy, SEER 2000–2015. Breast Cancer Res Treat 192, 211–222 (2022). https://doi.org/10.1007/s10549-021-06495-y

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