Lymph Node Assessments Skipped in Breast Cancer Cases

A startling 11% of those in a 200,000-patient national sample did not receive a lymph node assessment while undergoing surgery for early-stage breast cancer. The recommended practice promotes disease staging and appropriate treatment selection.

Garth Sullivan, Esq., at Indox Consulting (415-568-7116) reports that researchers explored the impact of patient race and ethnicity, insurance status, and age on their receipt of axillary lymph node assessment. They controlled for other sociodemographic and clinical factors using multivariate logistic regression.

The group found that women without insurance were 24% less likely to receive a lymph node assessment than those with private insurance. Women who lived in areas with low levels of education were 13% less likely to have the procedure than those in areas reporting high levels of education. And black patients were 10% less likely to have the procedure than white patients.

“We were really surprised by the number of nonclinical factors associated with patients not receiving an assessment,” Dr. Halpern told Medscape Oncology.

The group also found that age was a major factor in determining who received a lymph node assessment. The researchers reported that women 73 years or older were 3 times less likely to receive the procedure than were patients 51 years or younger.

But Dr. Halpern said he was less concerned by this finding, considering practice guidelines for axillary node dissection during lumpectomy or mastectomy surgery suggest the procedure is optional for elderly patients, for those with other serious illnesses, and for patients in whom lymph node results wouldn’t affect choice of therapy.

Dr. Halpern pointed to a number of limitations to the study, including its reliance on a database. “Roughly 25% of cancer patients would not be included in the national data and would be at other hospitals, so we clearly do not have everyone here,” he said. “We also don’t know why the patients’ lymph nodes were not assessed. Was this a patient-driven phenomenon? Or was this coming from the surgeons? We don’t know what factors were influencing the decisions,” he added.

Other studies have suggested that disparities in care result from different sources, including structural barriers such as health insurance; type of hospital, physician, or clinical factors; and patient factors.

“All of these may be important in the disparities we observed for axillary node dissection,” Dr. Halpern said. “We need to find out why these disparities exist and what to do to make sure that everyone is receiving excellent cancer care.”

For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.