Racial and Ethnic Disparities in Oncotype DX Test Receipt in a Statewide Population-Based Study

View More View Less
  • a From Cancer Outcomes Public Policy Effectiveness Research (COPPER) Center, Yale University; Section of General Internal Medicine, Yale University; Smilow Cancer Hospital, Yale New Haven Hospital; Yale Cancer Center Rapid Case Ascertainment Center; and Yale School of Public Health, New Haven, Connecticut.
Restricted access

Background: Racial disparities have been reported in breast cancer care, yet little is known about disparities in access to gene expression profiling (GEP) tests. Given the impact of GEP test results, such as those of Oncotype DX (ODx), on treatment decision-making for hormone receptor–positive (HR+) breast cancer, it is particularly important to assess disparities in its use. Methods: We conducted a retrospective population-based study of 8,784 patients diagnosed with breast cancer in Connecticut during 2011 through 2013. We assessed the association between race, ethnicity, and ODx receipt among women with HR+ breast cancer for whom NCCN does and does not recommend ODx testing, using bivariate and multivariate logistic analyses. Results: We identified 5,294 women who met study inclusion criteria: 83.8% were white, 6.3% black, and 7.4% Hispanic. Overall, 50.9% (n=4,131) of women in the guideline-recommended group received ODx testing compared with 18.5% (n=1,163) in the nonrecommended group. More white women received the ODx test compared with black and Hispanic women in the recommended and nonrecommended groups (51.4% vs 44.6% and 47.7%; and 21.2% vs 9.0% and 9.7%, respectively). After adjusting for tumor and clinical characteristics, we observed significantly lower ODx use among black (odds ratio [OR], 0.64; 95% CI, 0.47–0.88) and Hispanic women (OR, 0.59; 95% CI, 0.45–0.77) compared with white women in the recommended group and in the guideline-discordant group (blacks: OR, 0.39; 95% CI, 0.20–0.78, and Hispanics: OR, 0.44; 95% CI, 0.23–0.85). Conclusions: In this population-based study, we identified racial disparities in ODx testing. Disparities in access to innovative cancer care technologies may further exacerbate existing disparities in breast cancer outcomes.

Author contributions: Project conception and initiation: Gross, Aminawung. Data acquisition: Rajni. Anaylsis: Aminawung. Drafting of manuscript: Davis, Aminawung. Interpretation of data and manuscript revision, review, and approval: Davis, Aminawung, Abu-Khalaf, Evans, Su, Mehta, Wang, Gross. Dr. Gross is the guarantor and affirms that the manuscript is an honest and accurate account of the study being reported.

Correspondence: Cary P. Gross, MD, Section of General Internal Medicine, Yale University School of Medicine, P.O. Box 208056, New Haven, CT 06520. E-mail: cary.gross@yale.edu
  • 1.

    Bigby J, Holmes M. Disparities across the breast cancer continuum. Cancer Causes Control 2005;16:3544.

  • 2.

    Elmore JG, Nakano CY, Linden HM. Racial inequities in the timing of breast cancer detection, diagnosis, and initiation of treatment. Med Care 2005;43:141148.

    • Search Google Scholar
    • Export Citation
  • 3.

    Fedewa SA, Ward EM, Stewart AK, Edge SB. Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic ppoulations: a national cohort study 2004-2006. J Clin Oncol 2010;28:41354141.

    • Search Google Scholar
    • Export Citation
  • 4.

    Adams SA, Smith ER, Hardin J. Racial differnces in follow-up of abnormal mammography findings among economically disadvantaged women. Cancer 2009;115:57885797.

    • Search Google Scholar
    • Export Citation
  • 5.

    Bickell NA, Wang JJ, Oluwole S. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 2006;24:13571362.

    • Search Google Scholar
    • Export Citation
  • 6.

    McCarthy EP, Burns RB, Coughlin SS. Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women. Ann Intern Med 1998;128:729736.

    • Search Google Scholar
    • Export Citation
  • 7.

    Ward E, Jemal A, Cokkinides V. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 2004;54:7893.

  • 8.

    van Ravesteyn NT, Schechter CB, Near AM. Race-specific impact of natural history, mammography screening, and adjuvant treatment on breast cancer mortality rates in the United States. Cancer Epidemiol Biomarkers Prev 2011;20:112122.

    • Search Google Scholar
    • Export Citation
  • 9.

    Tehranifar P, Neugut AI, Phelan JC, Link BG. Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomarkers Prev 2009;18:27012708.

    • Search Google Scholar
    • Export Citation
  • 10.

    Paik S, Tang G, Shak S. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol 2006;24:37263734.

    • Search Google Scholar
    • Export Citation
  • 11.

    Gradishar WJ, Anderson BO, Blair SL. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer, version 3.2014. Accessed September 14, 2014. To view the most recent version of these guidelines, visit NCCN.org.

    • Search Google Scholar
    • Export Citation
  • 12.

    Carlson RW, Allred DC, Anderson BO. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2009;7:122192.

  • 13.

    Gradishar WJ, Anderson BO, Balassanian R. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer, version 3.2015. Accessed October 10, 2016. To view the most recent version of these guidelines, visit NCCN.org.

    • Search Google Scholar
    • Export Citation
  • 14.

    Su KW, Hall J, Soulos PR. Association of 21-gene recurrence score assay and adjuvant chemotherapy use in the medicare population, 2008-2011. J Geriatric Oncol 2016;7:1523.

    • Search Google Scholar
    • Export Citation
  • 15.

    Sheppard VB, O'Neill SC, Dilawari A. Patterns of 21-gene assay testing and chemotherapy use in black and white breast cancer patients. Clin Breast Cancer 2015;15:e8392.

    • Search Google Scholar
    • Export Citation
  • 16.

    Roberts MC, Weinberger M, Dusetzina SB. Racial variation in the uptake of Oncotype DX testing for early-stage breast cancer. J Clin Oncol 2016;34:130138.

    • Search Google Scholar
    • Export Citation
  • 17.

    Lund MJ, Mosunjac M, Davis KM. 21-Gene recurrence scores: racial differences in testing, scores, treatment, and outcome. Cancer 2012;118:788796.

    • Search Google Scholar
    • Export Citation
  • 18.

    Hassett MJ, Silver SM, Hughes ME. Adoption of gene expression profile testing and association with use of chemotherapy among women with breast cancer. J Clin Oncol 2012;30:22182226.

    • Search Google Scholar
    • Export Citation
  • 19.

    Haas JS, Phillips KA, Liang SY. Genomic testing and therapies for breast cancer in clinical practice. J Clin Oncol 2011;7(3 Suppl):e1s7s.

  • 20.

    Guth AA, Fineberg S, Fei K. Utilization of Oncotype DX in an inner city population: race or place? Int J Breast Cancer 2013;2013:653805.

  • 21.

    Dinan MA, Mi X, Reed SD. Initial trends in the use of the 21-gene recurrence score assay for patients with breast cancer in the Medicare population, 2005-2009. JAMA Oncol 2015;1:158166.

    • Search Google Scholar
    • Export Citation
  • 22.

    DeFrank JT, Salz T, Reeder-Hayes K, Brewer NT. Who gets genomic testing for breast cancer recurrence risk? Public Health Genomics 2013;16:215222.

    • Search Google Scholar
    • Export Citation
  • 23.

    Jasem J, Amini A, Rabinovitch R. 21-gene recurrence score assay as a predictor of adjuvant chemotherapy administration for early-stage breast cancer: an analysis of use, therapeutic implications, and disparity profile. J Clin Oncol 2016;34:19952002.

    • Search Google Scholar
    • Export Citation
  • 24.

    Cress RD, Chen YS, Morris CR. Underutilization of gene expression profiling for early-stage breast cancer in California. Cancer Causes Control 2016;27:721727.

    • Search Google Scholar
    • Export Citation
  • 25.

    O'Neill SC, Isaacs C, Chao C. Adoption of gene expression profiling for breast cancer in US oncology practice for women younger than 65 years. J Natl Compr Canc Netw 2015;13:12161224.

    • Search Google Scholar
    • Export Citation
  • 26.

    Gaskin DJ, Dinwiddie GY, Chan KS, McCleary R. Residential segregation and disparities in health care services utilization. Med Care Res Rev 2011;69:158175.

    • Search Google Scholar
    • Export Citation
  • 27.

    Saloner B, Lê Cook B. Blacks and Hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors. Health Aff (Millwood) 2013;32:135145.

    • Search Google Scholar
    • Export Citation
  • 28.

    Kawachi I, Daniels N, Robinson DE. Health disparities by race and class: why both matter. Health Aff (Millwood) 2005;24:343352.

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1146 384 48
PDF Downloads 255 136 18
EPUB Downloads 0 0 0