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Factors Associated with Variance in Compliance with a Sentinel Lymph Node Dissection Quality Measure in Early-Stage Breast Cancer

  • American Society of Breast Surgeons
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Guidelines recommend sentinel lymph node dissection (SLND) for patients with clinical stage I/IIA/IIB breast cancer; however, a significant fraction of patients do not undergo this procedure. We sought to identify factors associated with noncompliance with the SLND benchmark in early-stage breast cancer.

Materials and Methods

All patients with an initial diagnosis of Stage I/IIA/IIB invasive breast carcinoma who were treated between 2004 and 2007 with records in the California Cancer Registry were evaluated. Odds ratios evaluating receipt of SLND were compared for sex, age, stage, socioeconomic status (SES), race/ethnicity, surgery type, year of diagnosis, and hospital cancer program approval from the American College of Surgery (ACOS).

Results

Of 55,207 patients identified, 66% underwent SLND. On multivariable analyses, patients were significantly less likely to undergo SLND if they were >65 years of age, stage IIA or IIB, of lower socioeconomic status, of nonwhite race/ethnicity, treated with total mastectomy, treated during 2004–2005, or at a non-ACOS approved institution.

Conclusions

SLND use in California has increased over time; however, only two-thirds of eligible patients undergo this recommended procedure. Using SLND as a quality measure demonstrates significant disparities that have implications not only for patient and provider education, but also for health care policy and reform.

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Acknowledgment

This study was supported in part by NCI/SEER contracts No. N01-PC-35136, N01-PC-35139, and N02-PC-15105, CDC/National Program for Cancer Registries contract No. U58DP000807-01, and the California Department of Public Health, Cancer Surveillance Branch.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, Loma Linda University School of Medicine, Loma Linda, CA, USA

    Windy Olaya MD, Jan Wong MD, Caitlyn Truong MD, Sharmila Roy-Chowdhury MD, Kevork Kazanjian MD & Sharon Lum MD

  2. School of Public Health, Loma Linda University, Loma Linda, CA, USA

    John W. Morgan DrPH

  3. California Cancer Registry, Desert Sierra Cancer Surveillance Program, Loma Linda University Medical Center, Loma Linda, CA, USA

    John W. Morgan DrPH & Sharon Lum MD

Authors
  1. Windy Olaya MD
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  2. Jan Wong MD
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  3. John W. Morgan DrPH
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  4. Caitlyn Truong MD
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  5. Sharmila Roy-Chowdhury MD
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  6. Kevork Kazanjian MD
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  7. Sharon Lum MD
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Corresponding author

Correspondence to Sharon Lum MD.

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Olaya, W., Wong, J., Morgan, J.W. et al. Factors Associated with Variance in Compliance with a Sentinel Lymph Node Dissection Quality Measure in Early-Stage Breast Cancer. Ann Surg Oncol 17 (Suppl 3), 297–302 (2010). https://doi.org/10.1245/s10434-010-1248-0

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  • DOI: https://doi.org/10.1245/s10434-010-1248-0

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