Cancer Staging In Black and White

Breast cancer staging disparities exist between black and white women

(RxWiki News) Breast cancer is more common in white women than in black women - yet the disease is more deadly in black women. This is just one of the disparities among breast cancer patients.

Black breast cancer patients are less likely than white women to have access to improved surgical techniques to see if the cancer has spread.

Sentinel lymph node (SLN) biopsies remove only the nodes closest to the tumor. This improved technique has been used for about 15 years.

A more invasive procedure is called an axillary lymph node dissection (ALND). This surgery removes the nodes in the armpit and can cause more complications.

"Find out how your cancer will be staged."

Dalliah Mashon Black, MD, assistant professor of surgery in the department of surgical oncology at The University of Texas MD Anderson Cancer Center, and colleagues conducted the study.

The researchers analyzed data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database to evaluate the differences in the use of SNL biopsies among black and white women. They also looked at how these variances impacted the risk of lymphedema, a difficult-to-treat condition that causes the arm to swell.

“These findings are an example of the need for continued improvements in disseminating national practice guidelines for breast cancer to surgeons and other breast cancer providers in all of our communities,” Dr. Black said in a press release.

Investigators examined the data on 31,274 women aged 66 or older who were treated for breast cancer between 2002 and 2007. This included 1,767 black women, 27,856 white women and 1,651 women of unknown or other race.

While 74 percent of white women had a SNL biopsy during this timeframe, 62 percent black women had the procedure. Black women were twice as likely to have lymphedema as white women who had undergone a SLN biopsy.

SNL biopsies were introduced in the mid-1990s and have been increasingly used to stage breast cancer – that is, describe how advanced the disease is. Today, SNL biopsies are the standard of care for staging early breast cancers.

Black concluded, “The fact that this disparity continued over time shows that new and improved surgical therapies may not be effectively implemented in some patient populations.”

And what does all this mean? Dr. Black said, “When we think of disparities, it doesn’t only mean that patients might be undertreated, but they could be overtreated with unnecessary and more radical procedures, leading to a higher risk for complications, as shown in this study,” she said.

Dr. Black’s team plans to update these findings using the 2010 SEER-Medicare data to see if there have been changes in these trends.

Dr. Black presented results from this study at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium. Research is considered preliminary before it is published in a peer-reviewed journal.

Review Date: 
December 2, 2012