The identification and treatment of isolated tumor cells reflect disparities in the delivery of breast cancer care

Joshua T. Tan, Melissa Bagnell, John W. Morgan, Jan H. Wong, Sharmila Roy-Chowdhury, Sharon S. Lum

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Disparities in the quality of health care delivered among different socioeconomic strata (SES), race/ethnic groups, and health care systems are well documented; however, relevant quality measures in breast cancer have been debated. The identification of isolated tumor cells (ITCs) in axillary lymph nodes of patients with breast cancer requires diagnosis of early stage disease, appropriate implementation of sentinel lymph node (SLN) dissection, and pathologic analysis of the SLN with serial sectioning and immunohistochemical staining. We hypothesized that ITCs could be interpreted as a quality indicator and sought to determine factors that are associated with the identification and treatment of ITCs. Methods: We performed a retrospective cohort review of women with N0(i+) breast cancer diagnosed between 2004 and 2006 in the California Cancer Registry. The proportions of patients in SES quintiles (1 = lowest, 5 = highest), race/ethnicity groups, and hospital surgical volume tertiles (low, 1-241 cases/y; medium, 242-491 cases/y; high, ≥492 cases/y) were compared for use of SLN dissection, identification of ITCs, and treatment of ITCs with additional axillary surgery or chemotherapy. Results: SLN dissections were performed less frequently in women of lower SES, of nonwhite race/ethnicity, and in hospitals with lower surgical volumes (P

Original languageEnglish (US)
Pages (from-to)508-510
Number of pages3
JournalAmerican Journal of Surgery
Volume198
Issue number4
DOIs
StatePublished - Oct 2009
Externally publishedYes

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Breast Neoplasms
Lymph Node Excision
Neoplasms
Therapeutics
Quality of Health Care
Ethnic Groups
Registries
Lymph Nodes
Staining and Labeling
Delivery of Health Care
Drug Therapy
Sentinel Lymph Node

Keywords

  • Breast cancer
  • Disparities
  • Isolated tumor cells
  • Sentinel lymph node dissection

ASJC Scopus subject areas

  • Surgery

Cite this

The identification and treatment of isolated tumor cells reflect disparities in the delivery of breast cancer care. / Tan, Joshua T.; Bagnell, Melissa; Morgan, John W.; Wong, Jan H.; Roy-Chowdhury, Sharmila; Lum, Sharon S.

In: American Journal of Surgery, Vol. 198, No. 4, 10.2009, p. 508-510.

Research output: Contribution to journalArticle

Tan, Joshua T. ; Bagnell, Melissa ; Morgan, John W. ; Wong, Jan H. ; Roy-Chowdhury, Sharmila ; Lum, Sharon S. / The identification and treatment of isolated tumor cells reflect disparities in the delivery of breast cancer care. In: American Journal of Surgery. 2009 ; Vol. 198, No. 4. pp. 508-510.
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