Utilization of lymph node dissection, race/ethnicity, and breast cancer outcomes.

Objectives: Although large differences by race/ethnicity in breast cancer survival are well established, it is unknown whether disparities in nodal surgery utilization explain the racial/ethnic disparities in survival among women with micrometastasis and macrometastasis in sentinel lymph nodes (SLNs).

Study Design: Retrospective cohort study.

Methods: Women with breast cancer who underwent sentinel lymph node biopsy (SLNB) and who were found to have nodal metastases were identified from the Surveillance, Epidemiology, and End Results database (1998-2005). Outcomes data were examined for patients who underwent SLNB alone versus SLNB with axillary lymph node dissection (ALND).

Results: Proportions of patients receiving SLNB alone or receiving SLNB with a complete ALND were not statistically different among women of different racial/ethnic backgrounds (P = .8). Patients of African American descent or Hispanic origin had reduced overall survival, whereas patients of Hispanic origin had reduced diseasespecific survival after adjusting for selected covariates. Adjusting for nodal surgery did not reduce racial/ethnic disparities in overall survival or disease-specific survival.

Conclusions: The disparities in survival among African American and Hispanic women with breast cancer are not explained by nodal surgery utilization among women with micrometastasis and macrometastasis in SLNs.