Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.
Cancer Causes Control. 2022 Jun;33(6):843-859. doi: 10.1007/s10552-022-01575-w. Epub 2022 Apr 27.
Molecular testing is a critical component of breast cancer care used to identify the presence of estrogen and/or progesterone receptors (jointly hormone receptors-HRs) and the expression of human epidermal growth factor 2 (HER2) on a tumor. Our objective was to characterize trends and predictors of lack of molecular testing among female breast cancer patients overall and by sociodemographic characteristics.
We examined data on female breast cancer patients diagnosed between 2010 and 2016 from Surveillance Epidemiology and End Results-18. Joinpoint regression analyses assessed annual percent change (APC) in lack of ER, PR, or HER2 testing. Multivariable, multilevel logistic regression models identified factors associated with lack of molecular testing.
A nominally lower proportion of rural patients did not receive molecular testing (e.g., 1.8% in rural vs. 2.3% in urban for HER2). For all tests, a higher proportion of Hispanic and non-Hispanic Black women were not tested. Across all characteristics, improvement in testing was noted, although disparities among groups remained. For example, lack of HER2 testing improved from 3.2 to 1.7% in White patients (APC = - 10.05) but was consistently higher in Black patients 3.9 to 2.3% (APC = - 8.21). Multivariable, multilevel models showed that older, non-Hispanic Black, and unpartnered women were at greater odds of not receiving molecular testing.
While lack of molecular testing of breast cancer patients is relatively rare, racial/ethnic, insurance status, and age-related disparities have been identified. To reduce testing and downstream treatment and outcome disparities, it is imperative for all breast cancer patients to receive molecular testing.
分子检测是乳腺癌护理的重要组成部分，用于确定肿瘤中雌激素和/或孕激素受体（统称激素受体-HRs）以及人表皮生长因子 2（HER2）的表达情况。我们的目的是描述总体以及按社会人口统计学特征的女性乳腺癌患者缺乏分子检测的趋势和预测因素。
我们研究了 2010 年至 2016 年间监测、流行病学和最终结果-18 数据库中女性乳腺癌患者的数据。联合点回归分析评估了缺乏 ER、PR 或 HER2 检测的年度百分比变化（APC）。多变量、多层次逻辑回归模型确定了与缺乏分子检测相关的因素。
农村患者未接受分子检测的比例较低（例如，农村地区为 1.8%，而城市地区为 2.3%，用于 HER2）。所有检测中，西班牙裔和非西班牙裔黑人女性未接受检测的比例更高。在所有特征中，检测情况都有所改善，尽管组间仍存在差异。例如，白人患者中 HER2 检测的缺乏从 3.2%降至 1.7%（APC=-10.05），但黑人患者的比例一直较高，从 3.9%降至 2.3%（APC=-8.21）。多变量、多层次模型显示，年龄较大、非西班牙裔黑人以及未婚女性接受分子检测的可能性更大。
尽管女性乳腺癌患者缺乏分子检测的情况相对较少，但已经确定了种族/民族、保险状况和年龄相关的差异。为了减少检测以及下游治疗和结果的差异，所有乳腺癌患者都必须接受分子检测。
