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Racial Variation in the Uptake of Oncotype DX Testing for Early-Stage Breast Cancer.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2016 Jan 10; Vol. 34 (2), pp. 130-8. Date of Electronic Publication: 2015 Nov 23. - Publication Year :
- 2016
-
Abstract
- Purpose: Oncotype DX (ODX) is a tumor gene-profiling test that aids in adjuvant chemotherapy decision-making. ODX has the potential to improve quality of care; however, if not equally accessible across racial groups, disparities in cancer care quality may persist or worsen. We examined racial disparities in ODX testing uptake.<br />Methods: We used data from the Carolina Breast Cancer Study, phase III, a longitudinal, population-based study of 2,998 North Carolina women who received a diagnosis of breast cancer between 2008 and 2014. Our primary analysis used modified Poisson regression to determine the association between race and whether ODX testing was ordered among two strata: node-negative and node-positive breast cancer.<br />Results: A total of 1,468 women with estrogen receptor-positive, human epidermal growth factor receptor-2-negative, stage I or II breast cancer met inclusion criteria. Black patients had higher-grade and larger tumors, more comorbidities, younger age at diagnosis, and lower socioeconomic status than non-black women. Overall, 42% of women had ODX test results in their pathology reports. Compared with those who did not receive ODX testing, women who received ODX testing tended to be younger and have medium tumor size and grade. Our regression analyses indicated no racial disparities in ODX uptake among node-negative patients. However, racial differences were detected among node-positive patients, with black patients being 46% less likely to receive ODX testing than non-black women (adjusted relative risk, 0.54; 95% CI, 0.35 to 0.84; P = .006).<br />Conclusion: We did not find racial disparities in ODX testing for node-negative patients for whom ODX testing is guideline recommended and widely covered by insurers. However, our findings suggest that a newer, non-guideline-concordant application of ODX testing for node-positive breast cancer was accessed less by black women than by non-black women, reflecting more guideline concordant care among black women.<br /> (© 2015 by American Society of Clinical Oncology.)
- Subjects :
- Adult
Aged
Breast Neoplasms chemistry
Clinical Trials, Phase II as Topic
Confounding Factors, Epidemiologic
ErbB Receptors analysis
Female
Gene Expression Profiling economics
Healthcare Disparities statistics & numerical data
Humans
Insurance Coverage
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
North Carolina epidemiology
Poisson Distribution
Practice Guidelines as Topic
Precision Medicine methods
Precision Medicine statistics & numerical data
Predictive Value of Tests
Research Design
Risk Assessment
Risk Factors
Black or African American statistics & numerical data
Breast Neoplasms ethnology
Breast Neoplasms pathology
Gene Expression Profiling statistics & numerical data
Healthcare Disparities ethnology
Molecular Targeted Therapy methods
Molecular Targeted Therapy statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 34
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 26598755
- Full Text :
- https://doi.org/10.1200/JCO.2015.63.2489