Factors associated with variance in compliance with a sentinel lymph node dissection quality measure in early-stage breast cancer

Background: Guidelines recommend sentinel lymph node dissection (SLND) for patients with clinical stage I/IIA/IIB breast cancer; however, a significant fraction of patients do not undergo this procedure. We sought to identify factors associated with noncompliance with the SLND benchmark in early-stage breast cancer. Materials and Methods: All patients with an initial diagnosis of Stage I/IIA/IIB invasive breast carcinoma who were treated between 2004 and 2007 with records in the California Cancer Registry were evaluated. Odds ratios evaluating receipt of SLND were compared for sex, age, stage, socioeconomic status (SES), race/ethnicity, surgery type, year of diagnosis, and hospital cancer program approval from the American College of Surgery (ACOS). Results: Of 55,207 patients identified, 66% underwent SLND. On multivariable analyses, patients were significantly less likely to undergo SLND if they were >65 years of age, stage IIA or IIB, of lower socioeconomic status, of nonwhite race/ethnicity, treated with total mastectomy, treated during 2004-2005, or at a non-ACOS approved institution. Conclusions: SLND use in California has increased over time; however, only two-thirds of eligible patients undergo this recommended procedure. Using SLND as a quality measure demonstrates significant disparities that have implications not only for patient and provider education, but also for health care policy and reform. © 2010 Society of Surgical Oncology.