Abstract P5-12-09: Clinical stage, not race, predicts receipt of sentinel lymph node biopsy in medically-underserved patients

Abstract

Abstract Background: Sentinel lymph node biopsy (SLNB) has replaced axillary node dissection for staging clinically node negative breast cancer patients. Previously, other investigators have found disparities in the rate of SLNB in African Americans. Therefore, we hypothesized that African Americans and Hispanics are offered SLNB less frequently than Caucasians in a large safety-net hospital. Methods: A retrospective review of female patients who underwent breast cancer surgery from 2002-2011 at a safety-net hospital was completed. Data was collected from the institutional cancer registry and medical record for: age at diagnosis, patient demographics, pathologic and clinical stage at presentation, and receipt of SLNB. Patients with clinically negative nodes (N0) were determined to be appropriate for SLNB. Patients with clinically positive nodes, biopsy proven nodal involvement, or stages IIIC or IV were deemed not appropriate for SLNB. Results: Of 566 patients, the mean age at diagnosis was 53 years (range: 28-79); 46% (n = 269) were Hispanic, 31% African American (n = 174), 17% Caucasian (n = 95) and 5% Asian/Other (n = 28). Based on clinical stage, which was available for 561 patients, 64% were eligible for SLNB. Of those, 95% received appropriate SLNB. Race was not a predictor of eligibility for or receipt of appropriate SLNB. TotalCaucasianAfrican AmericanHispanicOtherp-value %(n = 566)%(n = 95)%(n = 95)%(n = 269)%(n = 28) Clinical Stage 0.70010.4 (59)7.4 (7)10.9 (19)11.2 (30)10.7 (3) 123.5 (133)25.3 (24)24.7 (43)22.7 (61)17.9 (5) 2A28.3 (160)29.5 (28)24.7 (43)11.5 (31)35.7 (10) 2B15.4 (87)18.9 (18)19.0 (33)7.1 (19)17.9 (5) 3A6.0 (34)5.3 (5)5.7 (10)7.8 (21)0 3B7.6 (43)8.4 (8)6.9 (12)7.8 (21)7.1 (2) 3C3.4 (19)1.1 (1)1.7 (3)5.2 (14)3.6 (1) 44.6 (26)3.2 (3)5.7 (10)4.5 (12)3.6 (1) Unknown0.9 (5)1.1 (1)5.7 (10)0.7 (2)3.6 (1) Appropriate for SLNB64.0 (362)67.4 (64)61.5 (107)63.2 (170)75.0 (21)0.48Received appropriate SLNB94.7 (343)93.8 (60)92.5 (99)95.9 (163)100.0 (21)0.28 Conclusions: There was no difference in the rate of SLNB between racial and ethnic minority patients at a large safety-net hospital. The previously reported disparity likely resulted from more advanced presentation of disease rather than lack of appropriate care. Efforts to improve disparities seen in medically underserved patients should be focused on earlier detection and treatment of breast cancer. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-12-09.