Gaps Persist in Use of Less Invasive Breast Cancer Procedure

(HealthDay News) -- The use of a less invasive form of sentinel lymph node biopsy (SLNB) during breast cancer surgery increased substantially in the United States from 1998 to 2005, researchers say. However, there are still disparities in terms of which women receive the therapy.

The study by the American Cancer Society found that non-white women, women aged 72 and older, and women living in poor areas of the country were less likely to receive the SLNB staging test than those who were white, younger, or live in more affluent areas.

In women diagnosed with breast cancer, doctors check to see if the cancer has spread from the breast tissue into neighboring lymph nodes. This can be done by removing many lymph nodes in a procedure called axillary lymph node dissection (ALND) or by removing a few lymph nodes (SLNB), which is associated with easier recovery and fewer long-term problems, according to background information in the study.

In this study, researchers analyzed national data on women who had breast cancer surgery between 1998 and 2005. Clinical care guidelines were changed in 1998 to allow surgeons to use SLNB in certain patients.

The proportion of patients who had SLNB increased from 26.8 percent in 1998 to 65.5 percent in 2005, the study found.

But the researchers also found that disparities in the use of SLNB persisted during those years. For example, in 1998, 29 percent of white women received SLNB, compared with 26 percent of black women, and 35 percent of Hispanic women. By 2005, the rates were 70 percent, 64 percent, and 67 percent, respectively.

According to clinical guidelines, SNLB should only be done in centers that have experienced teams. This study didn't examine whether the disparities in access to SLNB may be related to lack of experience at certain facilities.

"The disparities that were related to receipt of SLNB in this study are particularly important in light of the clinical advantages associated with this technique. Better outcomes have been reported for patients receiving SLNB than for patients receiving ALND," the researchers wrote.

The study was published online March 25 in the Journal of the National Cancer Institute.

"Given America's track record of disparate care, I suppose we should not be surprised that racial and ethnic minorities were disproportionately deprived of another medial advance," Dr. Stephen B. Edge, of Roswell Park Cancer Institute in Buffalo, wrote in an accompanying editorial. "However, this observation is profoundly disappointing and sobering. It is yet another call for us to redouble efforts to identify and correct the root cause of disparities."

More information
The U.S. National Cancer Institute has more about SLNB.

Heart Failure Raises Risks After Non-Cardiac Surgeries

(HealthDay News) -- Older people with heart failure face heightened odds of complications and death after non-cardiac surgeries, according to the largest study ever conducted on the issue.

"We're trying to draw attention to this major problem," said lead researcher Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University in Durham, N.C.

Heart failure, the progressive loss of the heart's ability to pump blood, is widespread among older Americans, but it sometimes is overlooked as a risk factor when surgery is needed, he said.

"Most physicians focus on whether [older patients] have coronary artery disease or have a risk of heart attack," Hernandez said. "Heart failure is by far a more important risk factor, but it doesn't usually have greater weight when they want to identify patients at risk of complications or consider how they want to treat them after surgery."

Symptoms of heart failure include shortness of breath, fatigue and swelling of the legs.

Hernandez' group published the study in the April issue of Anesthesiology. They used Medicare data on more than 159,000 people undergoing major surgery not involving the heart, such as hip replacement operations. Past estimates have put the incidence of heart failure in the older population between 5 percent and 12 percent, but the new study found the condition in almost 20 percent of those having surgery.

The study divided the participants into three groups: those with heart failure, with or without coronary artery disease; those with only coronary artery disease; and those with neither condition.

Nearly 98 percent of all those who had surgery were discharged soon afterward from the hospital. But 17.1 percent of those with heart failure had to be re-hospitalized within 30 days, compared to 10.8 percent of those with coronary artery disease and just 8.1 percent of those with neither ailment.

In the month after a surgery, 1.6 percent of those with heart failure died, compared to 0.5 percent for those with coronary artery disease and 0.3 percent of those with neither condition, the study found.

Steps can be taken to reduce the toll, Hernandez said.

"The first thing is to check on what the conditions are that might influence the patients outcomes," he said. "We have to identify therapies that lower the risk of a poor outcome and assure that all patients, when they have surgery, are carefully monitored."

Close attention should be paid to be sure that symptoms of heart failure are kept to a minimum, Hernandez said. Medications such as beta blockers and diuretics can be used to keep heart failure under control, he added.

But he noted that it's not certain how effective such measures might be in reducing risks -- only a rigorous, controlled study could answer that question definitively.

"We are planning to do such studies, but our planning is still in the early stages," he said. "We still need to identify sponsors of such a study."

One expert applauded the new research.

The increase in surgery risk due to heart failure has been noted before, but "this is a big study that involves a lot of people. It solidifies that the risk is real, and the risk is substantial," said Dr. Robert Hobbs, a staff cardiologist at the Cleveland Clinic whose work covers heart failure and transplant medicine.

Measures that can be taken to reduce the risk include simply not performing surgery, if possible, on someone whose life might be endangered, Hobbs said. "If surgery is necessary for someone with heart failure, there should be targeted use of heart failure medications before the operation and an effort to avoid overloading the body with intravenous fluid during the procedure," he said.

"And we would certainly watch them more carefully in the postoperative period," Hobbs added.

More information
Learn about heart failure, its symptoms and treatment, from the U.S. Library of Medicine.

Poison Prevention Tips to Protect the Most Vulnerable

(HealthDay News) -- To mark National Poison Prevention Week, which concludes Saturday, the Soap and Detergent Association offers a home safety checklist for parents with young children.

Parents and caregivers should:

• Install child-safety locks on cabinets that house cleaning supplies, medicines, cosmetics, chemicals and other poisons. Never assume a cabinet is too high for a child.
• Keep all household products in their original packaging, which includes useful first-aid information in the event of accidental exposure or ingestion. If you purchase household products in bulk, buy a smaller size of the same product and use this container for refills.
• Use child-resistant packaging properly by closing the container securely after each use.
• Keep in mind that this type of packaging is child-resistant, but not child-proof, and products must still be stored out of reach of children.
• Read and follow the directions on the product label. Pay particular attention to labels that include the words "Caution," "Warning," "Danger," or "Poison."
• When using cleaning products, take out only what's needed for the job at hand. Store the rest in a secure location.
• Don't mix household cleaning products. Doing so could release harmful vapors or cause other dangerous chemical reactions.
• Don't leave cleaning buckets unattended. If a child falls into the bucket, it may not tip over and the child could drown. If the bucket is tipped, the contents could spill and come into contact with a child's sensitive skin. Immediately clean up any spills and quickly and safely dispose of rags, paper towels and related items that you used to clean up a spill.
• Schedule house cleaning when children are having a nap, on a play date, or at school.
  If children are present while you're cleaning, avoid any distractions. If you need to answer the door, take the child with you. If the phone rings, let the answering machine get it.
• Know where to call for help. Post the Poison Control Center phone number (1-800-222-1222), along with other emergency numbers, by every land phone in your home, and enter the numbers into your cell phone's address book.

More information

The U.S. Centers for Disease Control and Prevention offers more tips to prevent poisonings.