Oncotype DX recurrence score implications for disparities in chemotherapy and breast cancer mortality in Georgia

• Type of Material: Article
• Authors: Lindsay J. Collin, Emory University; Ming Yan, Emory University; Renjian Jiang, Emory University; Kevin C. Ward, Emory University; Brittany Crawford, University of South Carolina; Mylin Torres, Emory University; Keerthi Gogineni, Emory University; Preeti D. Subhedar, Emory University; Samantha Puvanesarajah, American Cancer Society; Mia M. Gaudet, Emory University; Lauren McCullough, Emory University
• Language: English
• Date: 2019-09-26
• Publisher: Nature Research (part of Springer Nature): Fully open access journals
• Publication Version: Final Published Version
• Copyright Statement: © 2019, The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1038/s41523-019-0129-3
• Title of Journal or Parent Work: npj Breast Cancer
• ISSN: 2374-4677
• Volume: 5
• Issue: 1
• Start Page: 32
• End Page: 32
• Grant/Funding Information: This project was supported, in part, by the Cancer Prevention and Control Research program; and the Winship Research Informatics shared resources, a core supported by the Winship Cancer Institute of Emory University.; The collection of cancer incidence data used in this study was supported by contract HHSN261201800003I; Task Order HHSN26100001 from the NCI; and cooperative agreement 5NU58DP003875-04 from the CDC.
• Keywords: ASSAY; Science & Technology; STAGE; ADJUVANT CHEMOTHERAPY; CLINICAL-TRIALS; WHITE WOMEN; SURVIVAL; Oncology; RACE; Life Sciences & Biomedicine; ETHNICITY; AFRICAN-AMERICAN; DIAGNOSIS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Oncology

Abstract

Among women diagnosed with stage I–IIIa, node-negative, hormone receptor (HR)-positive breast cancer (BC), Oncotype DX recurrence scores (ODX RS) inform chemotherapy treatment decisions. Differences in recurrence scores or testing may contribute to racial disparities in BC mortality among women with HR+ tumors. We identified 12,081 non-Hispanic White (NHW) and non-Hispanic Black (NHB) BC patients in Georgia (2010–2014), eligible to receive an ODX RS. Logistic regression was used to estimate the odds of chemotherapy receipt by race and ODX RS. Cox proportional hazard regression was used to calculate the hazard ratios (HRs) comparing BC mortality rates by race and recurrence score. Receipt of Oncotype testing was consistent between NHB and NHW women. Receipt of chemotherapy was generally comparable within strata of ODX RS—although NHB women with low scores were slightly more likely to receive chemotherapy (OR = 1.16, 95% CI 0.77, 1.75), and NHB women with high scores less likely to receive chemotherapy (OR = 0.77, 95% CI 0.48, 1.24), than NHW counterparts. NHB women with a low recurrence score had the largest hazard of BC mortality (HR = 2.47 95% CI 1.22, 4.99) compared to NHW women. Our data suggest that additional tumor heterogeneity, or other downstream treatment factors, not captured by ODX, may be drivers of racial disparities in HR+ BC.