Cancer Outcomes Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut
Section of General Internal Medicine, Yale University, New Haven, Connecticut
J Natl Compr Canc Netw. 2017 Mar;15(3):346-354. doi: 10.6004/jnccn.2017.0034.
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. 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. 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). 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.
种族差异在乳腺癌护理中已有报道，但对于基因表达谱（GEP）检测的获取差异知之甚少。鉴于 GEP 检测结果（如 Oncotype DX（ODx））对激素受体阳性（HR+）乳腺癌治疗决策的影响，评估其使用差异尤为重要。我们对 2011 年至 2013 年间在康涅狄格州诊断为乳腺癌的 8784 名患者进行了一项回顾性基于人群的研究。我们使用二变量和多变量逻辑分析，评估了 HR+乳腺癌患者中 NCCN 推荐和不推荐 ODx 检测的种族、族裔与 ODx 接受情况之间的关联。我们确定了符合研究纳入标准的 5294 名女性：83.8%为白人，6.3%为黑人，7.4%为西班牙裔。总体而言，在指南推荐组中，50.9%（n=4131）的女性接受了 ODx 检测，而在不推荐组中，这一比例为 18.5%（n=1163）。在推荐和不推荐组中，白人女性接受 ODx 检测的比例均高于黑人女性和西班牙裔女性（分别为 51.4%比 44.6%和 47.7%；21.2%比 9.0%和 9.7%）。在调整肿瘤和临床特征后，我们观察到在推荐组和指南不一致组中，黑人（比值比 [OR]，0.64；95%置信区间 [CI]，0.47-0.88）和西班牙裔（OR，0.59；95%CI，0.45-0.77）女性的 ODx 使用率明显低于白人女性，黑人（OR，0.39；95%CI，0.20-0.78，西班牙裔：OR，0.44；95%CI，0.23-0.85）。在这项基于人群的研究中，我们发现 ODx 检测存在种族差异。创新癌症治疗技术获取方面的差异可能会进一步加剧乳腺癌结局方面现有的差异。
