Fielder Abigail M, Kim Seongho, Ruterbusch Julie J, Martin Cydnie, Gottschlich Anna, Schwartz Ann G, Beebe-Dimmer Jennifer L, Assad Hadeel, Hamel Lauren, Purrington Kristen S
Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.
Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, 4100 John R, MM04EP, Detroit, MI, 48201, USA.
Breast Cancer Res Treat. 2025 Sep 9. doi: 10.1007/s10549-025-07816-1.
Black women with hormone receptor-positive (HR +) breast cancer are twice as likely as White women to have weakly HR + tumors (1-10% positive cells). Patients with weakly HR + tumors are less frequently prescribed ET and have 60% higher mortality than strongly HR + tumors (> 10% positive cells). We evaluated factors associated with ET prescription and self-reported use among Black women with HR + breast cancer.
Among 922 Detroit ROCS participants, we evaluated associations between demographics, socioeconomic status, and health, tumor, oncologist, and hospital characteristics and ET prescription intent and self-reported ET use. Logistic mixed-effects regression was used to account for oncologist and hospital group effects.
Oncologists intended to prescribe ET to 83.4% of participants (n = 769), of which 54.4% (n = 502) reported use. In multivariable models, participants with weakly HR + tumors were 90% less likely to be prescribed ET (OR = 0.10, p < 0.0001). Other significant characteristics of ET prescription included a BMI of 25-29.9 kg/m (OR = 0.45, p = 0.0085), HR positivity > 90% vs. 11-90% (OR = 0.37, p = 0.00045), unknown HR percentage (OR = 0.12, p < 0.0001), OncotypeDx testing (OR = 2.65, p < 0.0001), and receiving radiation (OR = 2.20, p = 0.00016). Self-reported ET use was lower among those with lower health literacy (OR = 0.017, p < 0.001), weak HR positivity (OR = 0.46, p = 0.0053), unknown HR percentage (OR = 0.074, p = 0.034), and older age at diagnosis (OR = 0.88, p = 0.002). Increased ET use was associated with an income between $60,000-$79,900 vs. < $20,000 (OR = 1.54, p = 0.035), higher comorbidity count (OR = 1.09, p = 0.0054), distant stage (OR = 2.03, p = 0.029), and surgery (OR = 2.35, p = 0.001).
Identifying multilevel factors related to ET use may inform strategies to improve ET uptake and survival among Black women with HR + breast cancer.
激素受体阳性（HR+）乳腺癌的黑人女性患弱HR+肿瘤（阳性细胞占1 - 10%）的可能性是白人女性的两倍。弱HR+肿瘤患者接受内分泌治疗（ET）的频率较低，且死亡率比强HR+肿瘤（阳性细胞>10%）患者高60%。我们评估了HR+乳腺癌黑人女性中与ET处方及自我报告使用情况相关的因素。
在922名底特律地区癌症监测系统（ROCS）参与者中，我们评估了人口统计学、社会经济地位、健康状况、肿瘤、肿瘤学家及医院特征与ET处方意向及自我报告的ET使用情况之间的关联。采用逻辑混合效应回归分析来考虑肿瘤学家和医院组效应。
肿瘤学家打算为83.4%的参与者（n = 769）开具ET处方，其中54.4%（n = 502）报告使用了ET。在多变量模型中，弱HR+肿瘤的参与者接受ET处方的可能性降低90%（比值比[OR]=0.10，p<0.0001）。ET处方的其他显著特征包括体重指数（BMI）为25 - 29.9kg/m²（OR = 0.45，p = 0.0085）、HR阳性率>90%与11 - 90%相比（OR = 0.37，p = 0.
