Disparities in the Use of Sentinel Lymph Node Dissection for Early Stage Breast Cancer.

BACKGROUND: Clinical trials have long established the long-term safety of omitting axillary lymph node dissection (ALND) after sentinel lymph node dissection (SLND) in patients with clinically node-negative early stage breast cancer. The variations in utilization of SLND and ALND in this patient population, however, are currently unknown. METHODS: Adult female patients (40 years and older) within the National Cancer Database diagnosed with breast cancer between January 2013 and December 2015, who had clinical T1-T2 and N0 disease, and who underwent either SLND (with or without subsequent ALND) or ALND were included. Differences in utilization across race, ethnicity, insurance type, facility, and residential characteristics were assessed using multivariable logistic regression. RESULTS: Overall, 271,689 patients were included, of which 26,527 (10%) received ALND and 245,162 (90%) underwent SLND. After adjusting for demographics and cancer characteristics, black (odds ratio [OR], 1.11; 95% confidence interval [95% CI], 1.06-1.17) and Hispanic women (OR, 1.16; 95% CI, 1.10-1.24) were more likely to receive ALND. Patients without health insurance (OR, 1.33; 95% CI, 1.19-1.47), compared with private health insurance, and those receiving treatment at community cancer centers (OR, 1.60; 95% CI, 1.53-1.67), compared with academic/research centers, were also more likely to receive ALND. CONCLUSIONS: Although the vast majority of women undergo SLND, significant disparities exist in its utilization for early stage breast cancer, with traditionally underserved patients receiving unwarranted extensive axillary surgery. Increased patient and surgeon education is needed to decrease variations in care that can affect patient's quality of life.

Variations in the utilization of immediate post-mastectomy breast reconstruction.

BACKGROUND: For female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical location of the patient. METHODS: Women ≥18 years old who underwent mastectomy for breast cancer diagnosed between 2000 and 2014 were eligible. Women with inflammatory BC, Stage IV BC diagnoses, and bilateral BC were excluded. Multivariable logistic regression, adjusting for patient and cancer characteristics, were used to assess the association between of race, marital status, and region on immediate PMBR utilization. RESULTS: 321,206 women were included and 24% underwent immediate PMBR (<4 months after mastectomy). Compared to white women, black and other non-white women (OR 0.67, 95% CI 0.65, 0.70 and OR 0.52, 95% CI 0.50, 0.53, respectively) were significantly less likely to receive PMBR. Additionally, women who were single (OR 0.72, 95% CI 0.70, 0.75) or no longer married (OR 0.84, 95% CI 0.82, 0.86) were significantly less likely to undergo breast reconstruction, compared to married women. Regional differences were also seen, with women in the Northeast (OR 2.11, 95% CI 2.05,2.17), Midwest (OR 1.53, 95% CI 1.48, 1.58) and South (OR 1.20, 95%CI 1.17, 1.23) all being more likely to undergo breast reconstruction compared to the West. DISCUSSION: Significant variations exist in the utilization of post-mastectomy breast reconstruction across race, marital status or geographical location of the patient. Further research is needed to elucidate these differences and identify areas for intervention to increase awareness, and access to reconstruction for all breast cancer patients.