Pathological examination of axillary lymph nodes (ALNs) as a predictor of survival in women with invasive breast cancer and associated health disparities

Background: Breast cancer is a leading cause of cancer death among US women of all races. Known reasons for US health disparities include access to care and quality of care. A recent study suggests that surgery of ALNs, necessary for pathological examination and staging, does not improve survival. The Surveillance Epidemiology and End Results (SEER) Program requires the collection of information regarding the examination of Ipsilateral ALNs. Purpose: To investigate whether pathological examination of ALNs predicts survival and differs in racial groups among women with invasive breast cancer. Methods: Secondary analysis was conducted on 184,853 women, diagnosed with breast cancer (stages I, IIA, IIB, or T3N1M0) during 2004-2007, and were residents of the population-based SEER Program's coverage area. Women were grouped by race and pathological examination of ALNs status. Results: While both racial groups received pathological examination of ALNs at ~74%, presence of examination proved more beneficial to Black women. Black women had a 15.1% difference in the 4-year survival of those who received pathological examination compared to those who did not. White women had a 9.8% difference and better 4-year survival. Survival trends and rates are further analyzed. Conclusion: Since both Black and White women had ALNs pathologically examined at similar rates, racial health disparities seen in this study may be attributed to quality of care rather than being an access issue. Other possibilities for these disparities will be discussed. Black women seem to have greater benefit from pathological examination of ALNs regarding survival. The benefit increases as time from diagnosis increases.