When early-stage breast cancer is removed, the surgeon usually removes one or more of the underarm lymph nodes during the surgery. The nodes are sent to a pathologist for evaluation to see if the cancer has spread to the lymph nodes.
There are two kinds of lymph node removal surgery:
- axillary lymph node dissection: the surgeon removes an irregular pad of fatty tissue in the armpit that contains the lymph nodes; this procedure usually removes 10 or more lymph nodes
- sentinel lymph node dissection: only the lymph node or nodes closest to the cancer -- the sentinel node(s) -- are removed
Sentinel lymph node dissection is the standard of care for women diagnosed with early-stage breast cancer. Axillary lymph node surgery takes longer to recover from and can increase the risk of complications, including lymphedema, which is swelling of the soft tissues of the arm, hand, trunk, or breast.
A large study has found that African American women are about 33% less likely than white women to have sentinel lymph node dissection; this difference was linked to a much higher risk of lymphedema risk in African American women.
The research, “Disparities in the utilization of axillary sentinel lymph node biopsy among black and white patients with node-negative breast cancer from 2002-2007,” was presented at the 2012 San Antonio Breast Cancer Symposium.
The researchers looked at the medical records of more than 31,200 women diagnosed with breast cancer from 2002 to 2007. Overall, the rate of sentinel lymph node surgery was:
- 62% for African American women
- 65% for other nonwhite women
- 74% for white women
By 2007, the rate of sentinel lymph node surgery was:
- 83% for white women
- 70% for African American women
The lower rate of sentinel lymph node surgery for African American women wasn’t affected by the women’s age, cancer characteristics, or type of breast cancer surgery (lumpectomy versus mastectomy).
The researchers suggested that socioeconomic factors, including:
- lower income
- less education
- living in an area with fewer breast surgeons
all affected whether a woman was less likely to have sentinel lymph node surgery. This study reinforces earlier research that has shown a link between socioeconomic factors and access to care, as well as quality of care and outcomes.
Being less likely to have sentinel lymph node surgery also was linked to a much higher risk of lymphedema:
- 18% of African American women who had axillary lymph node surgery had lymphedema
- 12.2% of white women who had axillary lymph node surgery had lymphedema
If you’re an African American woman who’s been diagnosed with early-stage breast cancer and your doctor recommends axillary lymph node surgery as part of your treatment plan, you may want to ask about this study. Ask why axillary lymph node surgery is recommended for you and how the results of this study may apply to your unique situation. Together, you and your doctor can make the best decisions for YOU.
You can learn more about axillary and sentinel lymph node surgery by visiting the Breastcancer.org Lymph Node Removal pages.
Editor's note: To make sure that women have the appropriate lymph node surgery, the American Society for Clinical Oncology released guidelines on sentinel lymph node biopsy for people diagnosed with early-stage breast cancer. The guidelines say sentinel lymph node biopsy SHOULD be offered under these circumstances:
- breast cancer in which there is more than one tumor, all of which have formed separately from one another (doctors call these multicentric tumors); these types of breast cancers are rare
- DCIS treated with mastectomy
- women who have previously had breast cancer surgery or axillary lymph node surgery
- women who have been treated before with chemotherapy or another systemoc treatment (treatment before surgery is called neoadjuvant treatment)
Sentinel node biopsy SHOULD NOT be offered under these circumstances:
- the cancer is 5 cm or larger or locally advanced (the cancer has spread extensively in the breast or to the nearby lymph nodes)
- the cancer is inflammatory breast cancer
- DCIS treated with lumpectomy
- the woman is pregnant
The guidelines also say:
- Women with negative sentinel node biopsies shouldn’t have axillary node surgery.
- Women with one or two positive sentinel nodes who plan to have lumpectomy plus radiation also don’t need axillary node surgery.
- Women who have one or more positive sentinel nodes and plan to have mastectomy with no radiation should be offered axillary node surgery.