Evidence map›Paper›PMID 40699532›Full record

ArticleAnnals of surgical oncology2025

Disparities in the Surgical Management of the Axilla by Self-Identified Race in the Multicenter Neoadjuvant I-SPY2 Trial.

Mandeep Kaur, Katrina Dimitroff, Judy C Boughey, Laura J Esserman, Christina Yau, Julia Tchou, Astrid Quirarte, Marie Catherine Lee, Marissa M Howard-McNatt, Kayla Switalla and 29 more

Abstract readAdaptive Clinical TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

39 authors.

Mandeep KaurSchool of Medicine, University of California San Francisco, San Francisco, CA, USA.
Katrina DimitroffUniversity of California San Francisco, San Francisco, CA, USA.
Judy C BougheyDepartment of Surgery, Mayo Clinic, Rochester, MN, USA.
Laura J EssermanDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Christina YauDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Julia TchouUniversity of Pennsylvania, Philadelphia, Pennsylvania, USA.
Astrid QuirarteDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Marie Catherine LeeComprehensive Breast Program, Moffitt Cancer Center, Tampa, FL, USA.
Marissa M Howard-McNattDepartment of Surgical Oncology, Wake Forest, Winston-Salem, NC, USA.
Kayla SwitallaDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Henry KuererDepartment of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Candice SauderDepartment of Surgery, UC Davis Health Comprehensive Cancer Center, Sacramento, CA, USA.
Lauren M PostlewaitDivision of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Cletus ArcieroDivision of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Roshni RaoDepartment of Surgery, Columbia University Medical Center, New York, NY, USA.
Anne WallaceDepartment of Surgery, University of California San Diego, San Diego, CA, USA.
Chantal ReynaDepartment of Surgery, Loyola University Medical Center, Chicago, IL, USA.
Kamran AhmedDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Lily GutnikDepartment of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Neil TaunkDepartment of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
Jane PerlmutterGemini Group, Ann Arbor, MI, USA.
Angela DeMichelePerelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Douglas YeeMasonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Nola M HyltonDepartment of Radiology, University of California, San Francisco, San Francisco, CA, USA.
W Fraser SymmansDepartment of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Hope S RugoDepartment of Medicine, University of California San Francisco, San Francisco, CA, USA.
Rebecca A ShatskyMoores Cancer Center, University of California San Diego, La Jolla, San Diego, CA, USA.
Claudine IsaacsLombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Sonali RudraDepartment of Surgery, MedStar Georgetown University, Washington, DC, USA.
Paula PohlmannDepartment of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Cheryl EwingDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Jasmine WongDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Michael AlvaradoDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Nora JaskowiakDepartment of Surgery, University of Chicago, Chicago, IL, USA.
Nicolas PrionasDepartment of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
Mehra GolshanDepartment of Surgery, Yale School of Medicine, New Haven, CT, USA.
Mara A PiltinDivision of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Olufunmilayo I OlopadeCenter for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, IL, USA.
Rita A MukhtarDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA. rita.mukhtar@ucsf.edu.

Funding

Women's CancerP30CA077598 · NCI · UNIVERSITY OF MINNESOTA TWIN CITIES · PI Timothy C. Hallstrom · 1998 to 2026
$100.4M
The I SPY 2.2 TRIAL: Evolving to Imaging and Molecular Biomarker Response Directed Adaptive Sequential Treatment to Optimize Breast Cancer OutcomesP01CA210961 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Nola M. Hylton-Watson · 2017 to 2026
$22.9M
PROJECT 3 – BIOLOGY OF DNA DEAMINASES IN CANCERP01CA234228 · NCI · UNIVERSITY OF TEXAS HLTH SCIENCE CENTER · PI Michael Allen Carpenter · 2019 to 2026
$14.5M
Disrupting insulin receptor function in breast cancerR01CA251600 · NCI · UNIVERSITY OF MINNESOTA · PI YEE, DOUGLAS · 2020 to 2024
$1.7M
NCI NIH HHS P01 CA210961NCI NIH HHS P01 CA234228NCI NIH HHS P30 CA077598NCI NIH HHS R01 CA251600NIH HHS P01CA210961
6 · The paper itself

Abstract

backgroundNeoadjuvant chemotherapy (NAC) may allow de-escalation of axillary surgery; yet treatment disparities persist. We aimed to assess race-based disparities in use of axillary lymph node surgery (ALND) among patients who achieve a nodal response in the context of a large, multicenter NAC trial.

methodsWe conducted a retrospective analysis of the I-SPY 2 trial. All patients received NAC, but type of surgery was not mandated. Multivariable logistic regression was used to predict odds ratio (OR) of undergoing ALND by race while adjusting for clinical and demographic confounders, including age, region, tumor receptor subtype, clinical and pathologic node status (cN and ypN +/-, respectively), and clinical and pathologic tumor size (cT and ypT, respectively).

resultsAmong 1394 patients, 79.4% identified as White, 11.2% Black, and 9.4% Asian/other. More than half (52.5%) were cN+ at baseline, and 66.9% were ypN- after NAC, with no significant differences in nodal downstaging by race. Overall ALND rates were higher in Black patients (50.6%) compared to White (37.5%) and Asian/other (38.9%) patients (p = 0.007). Notably, among those who converted from cN+ to ypN-, Black patients underwent ALND more frequently (62%) than White (41.2%) and Asian/other (40%) patients (p = 0.021). In multivariable analysis, Black patients had 70% higher odds of undergoing ALND compared with White patients (OR 1.7, 95% confidence interval (CI) 1.09-2.66, p = 0.02).

conclusionsDespite no differences in nodal downstaging, Black patients in I-SPY 2 were significantly more likely to undergo ALND. These disparities may stem from unmeasured patient, provider, or systemic factors affecting surgical planning.

Indexed as

Breast NeoplasmsHealthcare DisparitiesLymph Node ExcisionLymph NodesRacial GroupsAdultAgedAntineoplastic Combined Chemotherapy ProtocolsAxillaFemaleFollow-Up StudiesHumansMiddle AgedNeoadjuvant TherapyNeoplasm StagingPrognosis

Identifiers

PMID40699532
PMCPMC12494629

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.