Racial disparities in omission of oncotype DX but no racial disparities in chemotherapy receipt following completed oncotype DX test results

Press, David J.; Ibraheem, Abiola; Dolan, M. Eileen; Goss, Kathleen H.; Conzen, Suzanne D.; Huo, Dezheng

doi:10.1007/s10549-017-4587-8

Cited by 30 publications

(38 citation statements)

References 35 publications

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“…These findings supplement earlier research showing that delays in the initiation of surgical treatment beyond 60 days 24 as well as delays in the time between surgery and the initiation of chemotherapy 18,23 are associated with decrements in breast cancer survival. It has been noted that therapeutically appropriate interventions, including breast reconstruction and gene expression profile testing, can drive some treatment delays 26 ; however, because reconstruction [27][28][29] and gene expression profile testing are used at similar rates 30 or lower rates [31][32][33][34] among black women and complications of breast reconstruction are similar across race, 35,36 such clinically appropriate delays are unlikely to explain the racial disparities that we have observed. Some previous literature has suggested that racial disparities in breast cancer treatment quality and timeliness may partially Cancer November 15, 2019 be explained by the characteristics of the institutions at which minority patients seek care, 37,38 their insurance status, and/or the distribution of minority patients in geographic areas with lower access or longer distance to care.…”

Section: Discussionmentioning

confidence: 72%

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Reeder‐Hayes

Mayer

Olshan

et al. 2019

Cancer

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Background After controlling for baseline disease factors, researchers have found that black women have worse breast cancer survival, and this suggests that treatment differences may contribute to poorer outcomes. Delays in initiating and completing treatment are one proposed mechanism. Methods Phase 3 of the Carolina Breast Cancer Study involved a large, population‐based cohort of women with incident breast cancer. For this analysis, we included black women (n = 1328) and white women (n = 1331) with stage I to III disease whose treatment included surgery with or without adjuvant therapies. A novel treatment pathway grouping was used to benchmark the treatment duration (surgery only, surgery plus chemotherapy, surgery plus radiation, or all 3). Models controlled for the treatment pathway, age, and tumor characteristics and for demographic factors related to health care access. Exploratory analyses of the association between delays and cancer recurrence were performed. Results In fully adjusted analyses, blacks had 1.73 times higher odds of treatment initiation more than 60 days after their diagnosis in comparison with whites (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.04‐2.90). Black race was also associated with a longer treatment duration. Blacks were also more likely to be in the highest quartile of treatment duration (OR, 1.69; 95% CI, 1.41‐2.02), even after adjustments for demographic and tumor characteristics (OR, 1.31; 95% CI, 1.04‐1.64). A nonsignificant trend toward a higher recurrence risk was observed for patients with delayed initiation (hazard ratio, 1.44; 95% CI, 0.89‐2.33) or the longest duration (hazard ratio, 1.17; 95% CI, 0.87‐1.59). Conclusions Black women more often had delayed treatment initiation and a longer duration than whites receiving similar treatment. Interventions that target access barriers may be needed to improve timely delivery of care.

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Section: Discussionmentioning

confidence: 72%

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Reeder‐Hayes

Mayer

Olshan

et al. 2019

Cancer

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“…Previous studies, including ours, have indicated that NHB women are more likely to be recommended chemotherapy and receive it than NHW counterparts. 20,23 Some studies have shown that with Oncotype DX testing, this difference in therapy decisions is mitigated. 23 In our study, we saw that this difference in treatment decision was mitigated in the low and intermediate recurrence score groups compared to women who did not receive ODX testing.…”

Section: Discussionmentioning

confidence: 99%

“…20,23 Some studies have shown that with Oncotype DX testing, this difference in therapy decisions is mitigated. 23 In our study, we saw that this difference in treatment decision was mitigated in the low and intermediate recurrence score groups compared to women who did not receive ODX testing. Data generated from clinical trials, have indicated that over prescribing chemotherapy among women with low ODX RS can lead to worse outcomes and may be a contributing factor to the observed racial disparities in BC mortality in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Results presented in the 2018 AACR San Antonio Breast Cancer Conference on clinical outcomes in breast cancer and race from the TAILORx trial, indicated that NHB women had worse clinical outcomes and a higher risk of recurrence despite similar 21-gene assay recurrence score results and adjuvant therapy. 43 This may suggest that the genes selected in the ODX RS may not be relevant to this population women and some proportion of NHB women with a low ODX RS may benefit from chemotherapy, although authors reported that TAILORx did not demonstrate a differential chemotherapy benefit in NHB women with an intermediate ODX RS (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), despite worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported variation in its application by age, socioeconomic status, and race, whereby younger breast cancer patients, higher income individuals, and non-Hispanic white (NHW) women are more likely to receive testing than other demographic subgroups. [19][20][21][22][23] Racial disparities in breast cancer outcomes in the US are welldocumented, with non-Hispanic black (NHB) women more likely to die from breast cancer than their white counterparts. Consistent with studies in other geographical areas, [24][25][26] we observed that in the metropolitan Atlanta area, racial disparities in breast cancer mortality were more robust among women diagnosed with more favorable prognostic tumors that are known to have highly effective adjuvant therapies.…”

Section: Introductionmentioning

confidence: 99%

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Oncotype DX recurrence score implications for disparities in chemotherapy and breast cancer mortality in Georgia

et al. 2019

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Among women diagnosed with stage I–IIIa, node-negative, hormone receptor (HR)-positive breast cancer (BC), Oncotype DX recurrence scores (ODX RS) inform chemotherapy treatment decisions. Differences in recurrence scores or testing may contribute to racial disparities in BC mortality among women with HR+ tumors. We identified 12,081 non-Hispanic White (NHW) and non-Hispanic Black (NHB) BC patients in Georgia (2010–2014), eligible to receive an ODX RS. Logistic regression was used to estimate the odds of chemotherapy receipt by race and ODX RS. Cox proportional hazard regression was used to calculate the hazard ratios (HRs) comparing BC mortality rates by race and recurrence score. Receipt of Oncotype testing was consistent between NHB and NHW women. Receipt of chemotherapy was generally comparable within strata of ODX RS—although NHB women with low scores were slightly more likely to receive chemotherapy (OR = 1.16, 95% CI 0.77, 1.75), and NHB women with high scores less likely to receive chemotherapy (OR = 0.77, 95% CI 0.48, 1.24), than NHW counterparts. NHB women with a low recurrence score had the largest hazard of BC mortality (HR = 2.47 95% CI 1.22, 4.99) compared to NHW women. Our data suggest that additional tumor heterogeneity, or other downstream treatment factors, not captured by ODX, may be drivers of racial disparities in HR+ BC.

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Propensity score analysis of the prognostic value of genomic assays for breast cancer in diverse populations using the National Cancer Data Base

Ibraheem

Olopade

Huo

2020

Cancer

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BackgroundGenomic assays such as Oncotype Dx (ODX) and MammaPrint are used for risk‐adapted treatment decisions among patients with early breast cancer. However, to the authors' knowledge, concordance between genomic assays is modest. Using real‐world data, the authors performed a comparative analysis of ODX and MammaPrint.MethodsA cohort of women diagnosed with early‐stage, hormone receptor–positive breast cancer who received ODX or MammaPrint was established using the National Cancer Data Base (NCDB) for 2010 through 2016. Using the propensity score matching method, 2 groups of patients with similar clinical and demographic characteristics were defined: one group received ODX and the other received MammaPrint. The authors examined the association between use of the ODX or MammaPrint assays and overall survival using Cox models.ResultsOf the 451,693 eligible patients, approximately 45.3% received ODX and 1.8% received MammaPrint testing. The use of ODX increased from 36.1% in 2010 to 49.9% in 2016, whereas use of MammaPrint increased from 0.5% in 2010 to 3.3% in 2016. The authors matched 5042 patients who received ODX with 5042 patients who received MammaPrint. The 5‐year risks of death for the MammaPrint low‐risk group and the ODX low‐risk group were 3.4% and 4.7%, respectively. The prognostic value of MammaPrint was similar to that of ODX; the C‐index was 0.614 (95% confidence interval, 0.572‐0.657) for MammaPrint and 0.581 (95% confidence interval, 0.530‐0.631) for ODX. There was a difference in the performance of the ODX assay observed across racial and/or ethnic groups (P < .001), with a slightly better performance noted among white compared with African American and Hispanic individuals.ConclusionsBoth the ODX and MammaPrint tests are good at identifying low‐risk individuals who could be spared chemotherapy. The suboptimal performance of ODX in ethnic minority individuals deserves further investigation.

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Racial disparities in omission of oncotype DX but no racial disparities in chemotherapy receipt following completed oncotype DX test results

Cited by 30 publications

References 35 publications

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Oncotype DX recurrence score implications for disparities in chemotherapy and breast cancer mortality in Georgia

Propensity score analysis of the prognostic value of genomic assays for breast cancer in diverse populations using the National Cancer Data Base

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