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Race and age disparities in receipt of sentinel lymph node biopsy for early-stage breast cancer

  • Epidemiology
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Abstract

To evaluate differences in use of sentinel lymph node biopsy (SLNB) by age and race in Medicare recipients with early-stage breast cancer, we examined Surveillance, Epidemiology and End Results—Medicare linked data for women undergoing breast conserving surgery for stage I or II breast cancer, including axillary staging, between January 2000 and December 2002. Multivariable generalized linear modeling with generalized estimating equations was used to identify predictors of receiving SLNB versus standard axillary lymph node dissection as the primary axillary staging modality. Women were significantly less likely to receive SLNB as their primary staging procedure if they were African American (OR 0.65), greater than 80 years of age (OR 0.71 vs. age <70), or dually eligible for Medicare and Medicaid (OR 0.61). Tumor characteristics, including well-differentiated histology and stage I disease, were associated with increased likelihood of SLNB, but estrogen receptor status was not a significant predictor. Women treated at an institution affiliated with an NCI cooperative research group had significantly greater likelihood of receiving SLNB (OR 2.31). Likelihood of receiving SLNB increased for women diagnosed in 2001 and 2002 compared with 2000. Significant disparities exist in receipt of SLNB in the Medicare population, with African Americans, the elderly, and economically disadvantaged patients being less likely to receive this innovative and morbidity-sparing procedure. These findings continue a previously observed pattern of reduced access to state of the art breast cancer care among underserved populations.

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Acknowledgments

This work was funded by NCI Grant 5R01CA124402. The lead author is supported by an NRSA T32 training grant. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Sect. 103885; NCI contracts N01-PC-35136, N01-PC-35139, and N02-PC-15105; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02. This study was reviewed and approved by University of North Carolina IRB #05-2761 (HPAA-1332).

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Authors and Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

    Bryan J. Weiner & William R. Carpenter

  2. Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes, John Bainbridge, Anne Marie Meyer, Bryan J. Weiner, Paul A. Godley & William R. Carpenter

  3. UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    Keith D. Amos, Bryan J. Weiner, Paul A. Godley & William R. Carpenter

  4. North Carolina Comprehensive Cancer Program, Raleigh, NC, USA

    Keith D. Amos, Paul A. Godley & William R. Carpenter

  5. Department of Hematology/Oncology, School of Medicine, UNC, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes & Paul A. Godley

  6. Department of Surgery, School of Medicine, UNC, Chapel Hill, NC, USA

    Keith D. Amos

  7. 170 Manning Drive, Chapel Hill, NC, 27599-7305, USA

    Katherine E. Reeder-Hayes

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  1. Katherine E. Reeder-Hayes
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  2. John Bainbridge
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  3. Anne Marie Meyer
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Correspondence to Katherine E. Reeder-Hayes.

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Reeder-Hayes, K.E., Bainbridge, J., Meyer, A.M. et al. Race and age disparities in receipt of sentinel lymph node biopsy for early-stage breast cancer. Breast Cancer Res Treat 128, 863–871 (2011). https://doi.org/10.1007/s10549-011-1398-1

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