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Author Notes:

Lindsay J. Collin: lindsay.jane.collin@emory.edu

L.E.M., M.A.T., L.J.C., M.M.G. and S.P. contributed to the study design and conceptualization; L.E.M., L.J.C., K.G. and P.D.S. contributed to the methodology; L.J.C., M.Y., R.J., B.C., L.E.M. and K.W. contributed to the data analysis, curation and interpretation; L.J.C., B.C. and L.E.M. contributed to the original manuscript preparation; L.E.M. and K.W. were responsible for funding ascertainment.

All authors participated in the review and editing of the manuscript for publication.

The authors gratefully acknowledge the contribution of the Greater-Atlanta Breast Cancer Task Force for their contribution to the development of this paper and unwavering efforts to reduce racial disparities in breast cancer mortality in Atlanta.

The authors additionally acknowledge the contributions of Dr. Timothy L. Lash for his support in the development of this project.

K.G. is on the advisory board with Pfizer and Lilly and has received research funding from Pfizer, Calithera, and Merck.

The remaining authors declare no competing interests.


Research Funding:

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.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • RACE

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

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Journal Title:

npj Breast Cancer


Volume 5, Number 1


, Pages 32-32

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2019, The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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