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Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing

  • Epidemiology
  • Published:
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Abstract

It is unknown whether racial differences exist in adjuvant chemotherapy initiation among women with similar oncotype DX (ODX) risk scores. We examined whether adjuvant chemotherapy initiation varied by race. Data come from the Phase III, Carolina Breast Cancer Study, a longitudinal, population-based study of North Carolina women diagnosed with breast cancer between 2008 and 2014. We used modified Poisson regression and report adjusted relative risk (aRR) and 95 % confidence intervals (95 %CI) to estimate the association between race and adjuvant chemotherapy initiation across ODX risk groups among women who received the test (n = 541). Among women who underwent ODX testing, 54.2, 37.5, and 8.3 % of women had tumors classified as low-, intermediate-, and high-risk groups, respectively. We observed no racial variation in adjuvant chemotherapy initiation. Increasing ODX risk score (aRR = 1.39, 95 %CI = 1.22, 1.58) and being married (aRR = 2.92, 95 %CI = 1.12, 7.60) were independently associated with an increased likelihood of adjuvant chemotherapy in the low-risk group. Among women in the intermediate-risk group, ODX risk score (aRR = 1.15, 95 %CI = 1.11, 1.20), younger age (aRR = 1.95, 95 %CI = 1.35, 2.81), larger tumor size (aRR = 1.70, 95 %CI = 1.22, 2.35), and higher income were independently associated with increased likelihood of adjuvant chemotherapy initiation. No racial differences were found in adjuvant chemotherapy initiation among women receiving ODX testing. As treatment decision-making becomes increasingly targeted with the use of genetic technologies, these results provide evidence that test results may drive treatment in a similar way across racial subgroups.

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Acknowledgements

We thank Dr. Andrew Olshan for facilitating the use of the Carolina Breast Cancer Study, Phase III data and for supporting this work. We also thank Mary Beth Bell, the Project Director for the CBCS, and Chiu Kit Tse for her programming and data management support. This work was funded in part by the University of North Carolina, Lineberger Cancer Control Education Program (CCEP) (R25 CA57726), the University Cancer Research Fund of North Carolina and the National Cancer Institute (NCI) Specialized Program of Research Excellence (SPORE) in Breast Cancer (P50-CA58223); By Author: MCR: CCEP (R25CA57726); MW: Veterans Affairs Health Services Research and Development Senior Research Career Scientist (RCS 91-408); SBD: National Institutes of Health (NIH) Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12 Program and North Carolina Translational and Clinical Sciences Institute (UL1TR001111); MAD: Agency for Healthcare Research and Quality (AHRQ) K99 HS022189; KRH: NIH BIRCWH, 5K12HD001441-12; MAT and LAC: P50-CA58223; SBW: AHRQ Comparative Effectiveness Research Career Development Award, 1-K-12 HS019468-01 and American Cancer Society Mentored Research Scholar Award, MRSG-13-17-01-CPPB.

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Authors and Affiliations

  1. Health Policy Management, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, McGavran Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA

    Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina & Stephanie B. Wheeler

  2. Lineberger Comprehensive Cancer Center, UNC, 1103C McGavran-Greenberg, CB# 7411, Chapel Hill, NC, 27599-7411, USA

    Megan C. Roberts, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Melissa A. Troester & Stephanie B. Wheeler

  3. Center for Health Services Research, Durham Veterans Affairs Medical Center, 1105b McGavran-Greeberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA

    Morris Weinberger

  4. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, UNC, 2203 Kerr Hall, CB# 7573, Chapel Hill, NC, 27599, USA

    Stacie B. Dusetzina

  5. Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA

    Michaela A. Dinan

  6. Duke Cancer Institute, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA

    Michaela A. Dinan

  7. Department of Medicine, School of Medicine, UNC, 170 Manning Drive, CB# 7305, Chapel Hill, NC, 27599, USA

    Katherine E. Reeder-Hayes & Lisa A. Carey

  8. Epidemiology, Gillings School of Global Public Health, UNC, 2104H McGavran-Greenberg, CB# 7435, Chapel Hill, NC, 27599-7435, USA

    Melissa A. Troester

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  1. Megan C. Roberts
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  2. Morris Weinberger
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  3. Stacie B. Dusetzina
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  4. Michaela A. Dinan
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  7. Lisa A. Carey
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  8. Stephanie B. Wheeler
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Correspondence to Megan C. Roberts.

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Dr. Michaela Dinan has been consulting for Salix; this work is unrelated to the research presented in this paper. The authors declare that they have no conflict of interest.

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Roberts, M.C., Weinberger, M., Dusetzina, S.B. et al. Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing. Breast Cancer Res Treat 153, 191–200 (2015). https://doi.org/10.1007/s10549-015-3518-9

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  • DOI: https://doi.org/10.1007/s10549-015-3518-9

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