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Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer

Abstract Background Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. The authors examined SLNB utilization in urban versus rural settings as this procedure was adopted and hypothesized that SLNB rates among urban populations increased faster, while the te... Full description

Journal Title: The American journal of surgery 2013, Vol.206 (5), p.674-681
Main Author: Arrington, Amanda K., M.D
Other Authors: Kruper, Laura, M.D , Vito, Courtney, M.D , Yim, John, M.D , Kim, Joseph, M.D , Chen, Steven L., M.D., M.B.A
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Elsevier Inc
ID: ISSN: 0002-9610
Link: https://www.ncbi.nlm.nih.gov/pubmed/24035212
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title: Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer
format: Article
creator:
  • Arrington, Amanda K., M.D
  • Kruper, Laura, M.D
  • Vito, Courtney, M.D
  • Yim, John, M.D
  • Kim, Joseph, M.D
  • Chen, Steven L., M.D., M.B.A
subjects:
  • Abridged Index Medicus
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Axilla
  • Biopsy
  • Breast
  • Breast cancer
  • Breast Neoplasms - pathology
  • Continental Population Groups - statistics & numerical data
  • Female
  • Humans
  • Lymph Node Excision - statistics & numerical data
  • Lymphatic system
  • Mastectomy - statistics & numerical data
  • Mastectomy, Segmental - statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Patients
  • Rural Health Services - statistics & numerical data
  • Rural-urban disparities
  • SEER Program
  • Sentinel lymph node
  • Sentinel Lymph Node Biopsy - utilization
  • Surgery
  • United States - epidemiology
  • Urban Health Services - statistics & numerical data
  • Young Adult
ispartof: The American journal of surgery, 2013, Vol.206 (5), p.674-681
description: Abstract Background Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. The authors examined SLNB utilization in urban versus rural settings as this procedure was adopted and hypothesized that SLNB rates among urban populations increased faster, while the technology shift and acceptance of SLNB were slower at rural centers. Methods The Surveillance, Epidemiology and End Results database was used to identify patients with invasive node-negative ductal or lobular breast cancer diagnosed from 1998 to 2008. Exclusion criteria were distant metastatic disease, T4 tumors, or incomplete data. Residential setting was divided into groups on the basis of population density. Results The overall rate of SLNB increased with time (from 10% in 1998 to 73% in 2008). The adoption of SLNB was slower in rural settings than among urban populations ( P < .001). By 2003, only urban areas were using SLNB in >50% of cases. Overall, there was a 2-year lag between the increases in SLNB utilization rates in these groups. There was a significant difference in SLNB rates according to tumor size. Conclusion The overall rate of SLNB remained near 50% and was lower in rural locations in 2004. By 2008, the SLNB rate for T1 and T2 tumors had increased to >50% in all population categories. SLNB utilization was lower in all population categories as tumor size increased. There was an overall 2-year lag in the adoption of SLNB in less populated areas. Although this may represent a more conservative approach, the difference may be attributable to a shortage of experienced surgeons, lack of training, or lack of technological support at smaller institutions.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-9610
fulltext: fulltext
issn:
  • 0002-9610
  • 1879-1883
url: Link


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titleRural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer
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creatorArrington, Amanda K., M.D ; Kruper, Laura, M.D ; Vito, Courtney, M.D ; Yim, John, M.D ; Kim, Joseph, M.D ; Chen, Steven L., M.D., M.B.A
creatorcontribArrington, Amanda K., M.D ; Kruper, Laura, M.D ; Vito, Courtney, M.D ; Yim, John, M.D ; Kim, Joseph, M.D ; Chen, Steven L., M.D., M.B.A
descriptionAbstract Background Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. The authors examined SLNB utilization in urban versus rural settings as this procedure was adopted and hypothesized that SLNB rates among urban populations increased faster, while the technology shift and acceptance of SLNB were slower at rural centers. Methods The Surveillance, Epidemiology and End Results database was used to identify patients with invasive node-negative ductal or lobular breast cancer diagnosed from 1998 to 2008. Exclusion criteria were distant metastatic disease, T4 tumors, or incomplete data. Residential setting was divided into groups on the basis of population density. Results The overall rate of SLNB increased with time (from 10% in 1998 to 73% in 2008). The adoption of SLNB was slower in rural settings than among urban populations ( P < .001). By 2003, only urban areas were using SLNB in >50% of cases. Overall, there was a 2-year lag between the increases in SLNB utilization rates in these groups. There was a significant difference in SLNB rates according to tumor size. Conclusion The overall rate of SLNB remained near 50% and was lower in rural locations in 2004. By 2008, the SLNB rate for T1 and T2 tumors had increased to >50% in all population categories. SLNB utilization was lower in all population categories as tumor size increased. There was an overall 2-year lag in the adoption of SLNB in less populated areas. Although this may represent a more conservative approach, the difference may be attributable to a shortage of experienced surgeons, lack of training, or lack of technological support at smaller institutions.
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descriptionAbstract Background Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. The authors examined SLNB utilization in urban versus rural settings as this procedure was adopted and hypothesized that SLNB rates among urban populations increased faster, while the technology shift and acceptance of SLNB were slower at rural centers. Methods The Surveillance, Epidemiology and End Results database was used to identify patients with invasive node-negative ductal or lobular breast cancer diagnosed from 1998 to 2008. Exclusion criteria were distant metastatic disease, T4 tumors, or incomplete data. Residential setting was divided into groups on the basis of population density. Results The overall rate of SLNB increased with time (from 10% in 1998 to 73% in 2008). The adoption of SLNB was slower in rural settings than among urban populations ( P < .001). By 2003, only urban areas were using SLNB in >50% of cases. Overall, there was a 2-year lag between the increases in SLNB utilization rates in these groups. There was a significant difference in SLNB rates according to tumor size. Conclusion The overall rate of SLNB remained near 50% and was lower in rural locations in 2004. By 2008, the SLNB rate for T1 and T2 tumors had increased to >50% in all population categories. SLNB utilization was lower in all population categories as tumor size increased. There was an overall 2-year lag in the adoption of SLNB in less populated areas. Although this may represent a more conservative approach, the difference may be attributable to a shortage of experienced surgeons, lack of training, or lack of technological support at smaller institutions.
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abstractAbstract Background Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. The authors examined SLNB utilization in urban versus rural settings as this procedure was adopted and hypothesized that SLNB rates among urban populations increased faster, while the technology shift and acceptance of SLNB were slower at rural centers. Methods The Surveillance, Epidemiology and End Results database was used to identify patients with invasive node-negative ductal or lobular breast cancer diagnosed from 1998 to 2008. Exclusion criteria were distant metastatic disease, T4 tumors, or incomplete data. Residential setting was divided into groups on the basis of population density. Results The overall rate of SLNB increased with time (from 10% in 1998 to 73% in 2008). The adoption of SLNB was slower in rural settings than among urban populations ( P < .001). By 2003, only urban areas were using SLNB in >50% of cases. Overall, there was a 2-year lag between the increases in SLNB utilization rates in these groups. There was a significant difference in SLNB rates according to tumor size. Conclusion The overall rate of SLNB remained near 50% and was lower in rural locations in 2004. By 2008, the SLNB rate for T1 and T2 tumors had increased to >50% in all population categories. SLNB utilization was lower in all population categories as tumor size increased. There was an overall 2-year lag in the adoption of SLNB in less populated areas. Although this may represent a more conservative approach, the difference may be attributable to a shortage of experienced surgeons, lack of training, or lack of technological support at smaller institutions.
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pubElsevier Inc
pmid24035212
doi10.1016/j.amjsurg.2013.07.007