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Cancer Causes Control. 2016 Jun;27(6):721-7. doi: 10.1007/s10552-016-0743-4. Epub 2016 Apr 20.

Underutilization of gene expression profiling for early-stage breast cancer in California.

Author information

1
Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA. rdcress@ucdavis.edu.
2
Cancer Registry of Greater California, Public Health Institute, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA. rdcress@ucdavis.edu.
3
Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA.
4
California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health System, Sacramento, CA, USA.
5
Division of Hematology/Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA.
6
School of Medicine, University of California, Davis, Sacramento, CA, USA.
7
Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA.

Abstract

PURPOSE:

To describe the utilization of gene expression profiling (GEP) among California breast cancer patients, identify predictors of use of GEP, and evaluate how utilization of GEP influenced treatment of early-stage breast cancer.

METHODS:

All women diagnosed with hormone-receptor-positive, node-negative breast cancer reported to the California Cancer Registry between January 2008 and December 2010 were linked to Oncotype DX (ODX) assay results.

RESULTS:

Overall, 26.7 % of 23,789 eligible patients underwent the assay during the study period. Women age 65 or older were much less likely than women under age 50 to be tested (15.1 vs. 41.4 %, p < 0.001). Black women were slightly less likely and Asian women were slightly more likely than non-Hispanic white women to undergo GEP with the ODX assay (22.2 and 28.9 vs. 26.9 %, respectively, p < 0.001). Patients residing in low SES census tracts had the lowest use of the test (8.9 %), with the proportion increasing with higher SES category. Women with Medicaid health insurance were less likely than other women to be tested (17.7 vs. 27.5 %, p < 0.001). Receipt of adjuvant chemotherapy (ACT) was associated with the ODX recurrence score, although only 63 % of patients whose recurrence scores indicated a high benefit received ACT. Of patients not tested, 15 % received ACT.

CONCLUSIONS:

Nearly three-fourths of eligible breast cancer patients in California during the 3-year period 2008 through 2010 did not undergo GEP. As a result, it is likely that many women unnecessarily received ACT and suffered associated morbidity. In addition, some high-risk women who would have benefited most from ACT were not identified.

KEYWORDS:

Breast cancer; Cancer registry; Chemotherapy; Gene expression profiling; Genomics

PMID:
27097910
PMCID:
PMC4871729
DOI:
10.1007/s10552-016-0743-4
[Indexed for MEDLINE]
Free PMC Article

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