ORIGINAL ARTICLE – HEALTHCARE POLICY AND OUTCOMES Disparities in Receipt of Lymph Node Biopsy Among Early-Stage Female Breast Cancer Patients Michael T. Halpern 1 , Amy Y. Chen 2,3 , Nicole S. Marlow 4 , and Elizabeth Ward 2 1 Division of Health Services and Social Policy Research, RTI International, 701 13th St. NW, Suite 750, Washington, DC 20005, USA; 2 Department of Health Services Research, American Cancer Society, Atlanta, GA, USA; 3 Department of Otolaryngology, Emory University, Atlanta, GA, USA; 4 Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, SC, USA ABSTRACT Accurate staging of early breast cancer requires pathological assessment of axillary lymph node involvement. We evaluated the proportion of women receiving surgery for early-stage breast cancer who do not receive any lymph node biopsy (LNB) and factors associ- ated with not receiving LNB. Patients receiving surgery for early-stage breast cancer (T1a/T1b/T1c/T2N0) during the period 2003–2005 were selected from the National Cancer Database. Patient sociodemographic, clinical, health insurance, and facility information was collected. Logistic regression was used to assess factors predictive of not receiving LNB. The number of women meeting study inclusion criteria was 184,050, 11% of whom did not receive any LNB. Compared with White patients, Black patients had greater likelihood [odds ratio (OR) 1.10, p \ 0.001] of receiving no LNB; there were no significant differences for Hispanic or other non-White patients. Individuals who were uninsured (OR 1.24, p \ 0.0005) or covered by Medicare at age \ 65 years (OR 1.29, p \ 0.0001) had greater likelihoods of no LNB compared with those with private insurance. Medicaid patients and Medicare patients C65 years were not significantly differ- ent from private insurance patients. Compared with the youngest quartile of patients (age B51 years), patients in the oldest quartile (age C73 years) were more than three times as likely (OR 3.30, p \ 0.0001) not to receive any LNB. We conclude that, while guidelines indicate that LNB may be considered optional in certain patient groups, it remains a key component in determining stage, and thereby prognosis and appropriate treatment options. These results indicate that significant disparities exist in sampling of axillary lymph nodes among women with early-stage breast cancer. Breast cancer is the leading cancer diagnosed in women, with approximately 182,460 new cases of invasive breast cancer expected to occur in women in 2008. 1 In order to determine the extent of lymph node involvement and accurately stage breast cancer, patients undergoing surgery for breast cancer generally receive lymph node biopsy/ sampling (LNB), which can consist of either axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB). Available recommendations specify that axillary lymph node surgery should be performed for breast cancer to guide further treatment decisions, and receipt of LNB as part of breast cancer surgery has been associated with increased survival. 2–7 However, published studies have indicated that not all patients receive LNB. Louwman et al. reported that, among patients undergoing breast-conserving surgery for breast cancer, those with comorbid conditions were less likely to receive LNB. 8 Using Surveillance, Epidemiology, and End Results (SEER) data, Gilligan et al. reported that older women and women residing in poorer counties were less likely to receive LNB. 9 Time- series data also indicated that rates of ALND decreased significantly in 1997–98 compared with in 1993–94, although rates of SLNB increased from 1998 to 2005. 10,11 A major resource for evaluating cancer treatment pat- terns in the USA is the National Cancer Database (NCDB), a hospital-based cancer registry jointly sponsored by the A portion of this work was performed while Michael Halpern and Nicole Marlow were members of the Dept. of Health Services Research, American Cancer Society, Atlanta GA. Ó Society of Surgical Oncology 2008 First Received: 1 August 2008; Published Online: 8 November 2008 M. T. Halpern e-mail: mhalpern@rti.org Ann Surg Oncol (2009) 16:562–570 DOI 10.1245/s10434-008-0205-7