21‐Gene recurrence scores

Lund, Mary Jo; Mošunjac, Marina; Davis, Kelly M.; Gabram-Mendola, Sheryl; Rizzo, M.; Bumpers, Harvey L.; Hearn, Sherita; Zelnak, Amelia; Styblo, Toncred M.; O’Regan, Ruth

doi:10.1002/cncr.26180

Cited by 61 publications

(35 citation statements)

References 27 publications

(56 reference statements)

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“…This differs significantly from preliminary ODX validation studies, where 27 % of women with early-stage breast cancer were classified as high risk [6]. Notably, subsequent observational studies have found the proportion of high-risk scores to be similar to what we observed [9]. In a qualitative study, providers discussed being less likely to order ODX testing for more aggressive tumors, because they felt that they already had the necessary information to offer adjuvant chemotherapy [15].…”

Section: Discussioncontrasting

confidence: 87%

“…In the intermediate-risk group, Black women had slightly higher ODX risk scores than non-Black women. However, the magnitude of this difference was small, and likely not clinically meaningful, corroborating a previous study that reported no significant racial differences in mean ODX risk scores [9]. Unlike that study, we did not observe significant racial differences in the distribution of women into ODX risk groups [9].…”

Section: Discussionsupporting

confidence: 77%

“…Second, we were unable to account for patient preferences, which likely play a role in ordering ODX testing and adjuvant chemotherapy decision-making [25]. Third, we lacked data on organizational and provider characteristics that influence adjuvant chemotherapy use [9, 26, 27]. Moving forward, it may be possible to link organizational- and provider-level data to the CBCS-III dataset, facilitating such analyses.…”

Section: Discussionmentioning

confidence: 99%

“…To date, little is known about adjuvant chemotherapy decision-making in the presence of ODX risk information in a population-based study. The only published study to examine this question did not find racial disparities in the use of adjuvant chemotherapy among women with ODX; however findings may not be generalizable, as it was conducted within three urban, academic-affiliated hospitals [9]. …”

Section: Introductionmentioning

confidence: 99%

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Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing

Roberts

Weinberger

Dusetzina

et al. 2015

Breast Cancer Res Treat

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It is unknown whether racial differences exist in adjuvant chemotherapy initiation among women with similar oncotype DX (ODX) risk scores. We examined whether adjuvant chemotherapy initiation varied by race. Data come from the Phase III, Carolina Breast Cancer Study, a longitudinal, population-based study of North Carolina women diagnosed with breast cancer between 2008 and 2014. We used modified Poisson regression and report adjusted relative risk (aRR) and 95 % confidence intervals (95 %CI) to estimate the association between race and adjuvant chemotherapy initiation across ODX risk groups among women who received the test (n = 541). Among women who underwent ODX testing, 54.2, 37.5, and 8.3 % of women had tumors classified as low-, intermediate-, and high-risk groups, respectively. We observed no racial variation in adjuvant chemotherapy initiation. Increasing ODX risk score (aRR = 1.39, 95 %CI = 1.22, 1.58) and being married (aRR = 2.92, 95 %CI = 1.12, 7.60) were independently associated with an increased likelihood of adjuvant chemotherapy in the low-risk group. Among women in the intermediate-risk group, ODX risk score (aRR = 1.15, 95 %CI = 1.11, 1.20), younger age (aRR = 1.95, 95 %CI = 1.35, 2.81), larger tumor size (aRR = 1.70, 95 %CI = 1.22, 2.35), and higher income were independently associated with increased likelihood of adjuvant chemotherapy initiation. No racial differences were found in adjuvant chemotherapy initiation among women receiving ODX testing. As treatment decision-making becomes increasingly targeted with the use of genetic technologies, these results provide evidence that test results may drive treatment in a similar way across racial subgroups.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing

Roberts

Weinberger

Dusetzina

et al. 2015

Breast Cancer Res Treat

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“…Previous studies, mainly conducted in a US health care setting, report contradictory results on the association between race, median income or educational status and GEP use. Some observed disparities [13,15,18], whereas others found no differences in GEP uptake [11,12]. In a US health care setting, disparities in GEP uptake between different socioeconomic classes may well be explained by financial inequalities.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Use of Gene Expression Profiles in Estrogen Receptor-Positive Early-Stage Breast Cancer Patients: A Nationwide Study

Kuijer

Schreuder²,

Elias³

et al. 2016

Public Health Genomics

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Background: Breast cancer guidelines suggest the use of gene expression profiles (GEPs) in estrogen receptor-positive (ER+) breast cancer patients in whom controversy exists regarding adjuvant chemotherapy benefit based on traditional prognostic factors alone. We evaluated the current use of GEPs in these patients in the Netherlands. Patients and Methods: Primary breast cancer patients treated between January 1, 2011 and December 31, 2014 and eligible for GEP use according to the Dutch national breast cancer guideline were identified in the Netherlands Cancer Registry: ER+ patients <70 years with grade 1 tumors >2 cm or grade 2 tumors 1-2 cm without overt lymph node metastases (pN0-Nmi). Mixed-effect logistic regression analysis was performed to associate characteristics of patients, tumors and hospitals with GEP use. Results: GEPs were increasingly deployed: 12% of eligible patients received a GEP in 2011 versus 46% in 2014. Lobular versus ductal morphology (OR 0.58, 95% CI 0.47-0.72), pN1mi status (versus pN0, OR 0.52, 95% CI 0.40-0.68), and tumor size (>3 cm vs. >2 cm, OR 0.33, 95% CI 0.14-0.88) were inversely associated with GEP use. High socioeconomic status (SES) (OR 1.32, 95% CI 1.06-1.64) and younger age (OR 0.96/year increasing age, 95% CI 0.95-0.96) were positively associated with GEP use. GEP use per hospital did vary, but no predefined institutional factors remained independently associated with GEP use. Conclusion: GEP use increased over time and was influenced by patient- and tumor-associated factors as well as by SES.

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Association of Race/Ethnicity and the 21-Gene Recurrence Score With Breast Cancer–Specific Mortality Among US Women

Hoskins

Danciu

et al. 2021

JAMA Oncol

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IMPORTANCEGiven the widespread use of the 21-gene recurrence score for identifying candidates for adjuvant chemotherapy, it is important to examine the performance of the Oncotype DX Breast Recurrence Score test in diverse patient populations to validate this approach for tailoring treatment in women in racial/ethnic minority groups.OBJECTIVE To examine whether breast cancer-specific mortality for women with hormone-dependent breast cancer differs by race/ethnicity across risk categories defined by the Oncotype DX Breast Recurrence Score test and whether the prognostic accuracy of the 21-gene recurrence score differs by race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study used the Surveillance, Epidemiology, and End Results Oncotype DX 2004-2015 database to obtain breast cancer-specific survival data on US women 18 years and older who were diagnosed with first primary stage I to III, estrogen receptor-positive breast cancer between January 1, 2004, and December 31, 2015, and had tumor testing through the Genomic Health Clinical Laboratory. Data were analyzed from April 20 to September 27, 2020. MAIN OUTCOMES AND MEASURESThe primary outcome was breast cancer-specific mortality among women from different racial/ethnic groups stratified by the 21-gene recurrence score risk categories. Secondary analyses compared the prognostic accuracy of the recurrence score among the different racial/ethnic groups.RESULTS A total of 86 033 patients with breast cancer (mean [SD] age, 57.6 [10.6] years) with Oncotype DX Breast Recurrence Score test information were available for the analysis, including 64 069 non-Hispanic White women (74.4%), 6719 non-Hispanic Black women (7.8%), 7944 Hispanic women (9.2%), 6950 Asian/Pacific Islander women (8.0%), and 351 American Indian/Alaska Native women (0.4%). Black women were significantly more likely than non-Hispanic White women to have a recurrence score greater than 25 (17.7% vs 13.7%; P < .001). Among women with axillary node-negative tumors, competing risk models adjusted for age, tumor characteristics, and treatment found higher breast cancer-specific mortality for Black compared with non-Hispanic White women within each recurrence score risk stratum, with subdistribution hazard ratios of 2.54 (95% CI, 1.44-4.50) for Black women with recurrence scores of 0 to 10, 1.64 (95% CI, 1.23-2.18) for Black women with recurrence scores of 11 to 25, and 1.48 (95% CI, 1.10-1.98) for Black women with scores greater than 25. The prognostic accuracy of the recurrence score was significantly lower for Black women, with a C index of 0.656 (95% CI, 0.592-0.720) compared with 0.700 (95% CI, 0.677-0.722) (P = .002) for non-Hispanic Whites. CONCLUSIONS AND RELEVANCEIn this cohort study, Black women in the US were more likely to have a high-risk recurrence score and to die of axillary node-negative breast cancer compared with non-Hispanic White women with comparable recurrence scores. The Oncotype DX Breast Recurrence Score test has lower prognostic accuracy in...

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21‐Gene recurrence scores

Cited by 61 publications

References 27 publications

Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing

Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing

Factors Associated with the Use of Gene Expression Profiles in Estrogen Receptor-Positive Early-Stage Breast Cancer Patients: A Nationwide Study

Association of Race/Ethnicity and the 21-Gene Recurrence Score With Breast Cancer–Specific Mortality Among US Women

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