Rural patients more likely to undergo sentinel node biopsy for breast cancer

The 2016 Choosing Wisely recommendation advised against routine sentinel lymph node biopsy (SLNB) for patients older than 70 with cT1-2N0, hormone receptor-positive, HER2-negative breast cancer, citing a lack of improved survival. Researchers used National Cancer Database data to assess whether rurality was associated with adherence to this recommendation among women meeting those criteria. They compared patient, tumor and treatment characteristics and used a random forest model to identify factors associated with SLNB use.

The cohort included 1,802,124 women. Compared with metropolitan patients, rural patients had longer travel distances to treatment and were more likely to receive care at a community facility, undergo SLNB, and undergo simple or modified radical mastectomy; all reported differences had P < 0.001. Age, T2 tumors, year of diagnosis and facility type were the model’s most important predictors of SLNB receipt.

The findings show an association between rurality and surgical management, but do not establish that rural residence itself caused differences in care. The authors note that factors related to rural care may mediate the association. As a retrospective database study, it describes practice patterns rather than the effects of SLNB on patient outcomes.