Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.
Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Cancer. 2020 Dec 15;126(24):5222-5229. doi: 10.1002/cncr.33150. Epub 2020 Sep 14.
Breast cancer is one of the most common causes of cancer mortality for all women, including American Indian and Alaska Native (AI/AN) women. The use of the 21-gene recurrence score (RS) appears to be predictive of the benefit of chemotherapy for women with estrogen receptor (ER)-positive breast cancer. The objective of the current study was to compare RS testing between AI/AN and non-Hispanic White (NHW) women with breast cancer.
The Surveillance, Epidemiology, and End Results program was used to identify women with ER-positive breast cancer from 2004 through 2015. Multivariable logistic regression was used to evaluate factors associated with RS use, with high-risk RS, and with chemotherapy use among those with a high-risk RS.
A total of 363,387 NHW patients and 1951 AI/AN patients with ER-positive breast cancer were identified. AI/AN women were found to be less likely to undergo RS testing and, when tested, were more likely to have a high-risk RS. In the multivariable logistic regression analysis, AI/AN women were found to be significantly more likely to have a high-risk RS (odds ratio,1.28; 95% confidence interval, 1.01-1.66). Among untested women, chemotherapy use was higher for AI/AN women; however, the use of chemotherapy was not found to be significantly different between the groups with a high-risk RS. Using Cox proportional hazards models, AI/AN race was found to be significantly associated with worse overall survival.
AI/AN women were less likely to undergo RS testing compared with NHW women and were more likely to have a high-risk RS. Reversing the disparity in genomic expression assay testing is critical to ensure guideline-based breast cancer treatment and improve survival rates for AI/AN women with breast cancer.
乳腺癌是所有女性癌症死亡的最常见原因之一，包括美国印第安人和阿拉斯加原住民（AI/AN）女性。21 基因复发评分（RS）的使用似乎可以预测雌激素受体（ER）阳性乳腺癌患者化疗的获益。本研究的目的是比较 AI/AN 和非西班牙裔白人（NHW）乳腺癌女性的 RS 检测情况。
利用监测、流行病学和最终结果计划（Surveillance, Epidemiology, and End Results program），从 2004 年至 2015 年，确定 ER 阳性乳腺癌患者。多变量逻辑回归用于评估与 RS 使用、高危 RS 以及高危 RS 患者中化疗使用相关的因素。
共确定了 363387 例 NHW 患者和 1951 例 ER 阳性乳腺癌的 AI/AN 患者。研究发现，AI/AN 女性进行 RS 检测的可能性较小，而在接受检测的患者中，发生高危 RS 的可能性更高。在多变量逻辑回归分析中，AI/AN 女性发生高危 RS 的可能性明显更高（比值比，1.28；95%置信区间，1.01-1.66）。在未接受检测的女性中，AI/AN 女性使用化疗的比例更高；然而，在高危 RS 组中，化疗的使用并未发现存在显著差异。使用 Cox 比例风险模型，AI/AN 种族与总生存显著相关。
与 NHW 女性相比，AI/AN 女性进行 RS 检测的可能性较小，且更有可能发生高危 RS。扭转基因组表达检测的差异对于确保基于指南的乳腺癌治疗并提高 AI/AN 乳腺癌女性的生存率至关重要。
