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Racial differences in genomic testing and receipt of endocrine therapy in early-stage breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Genomic testing in early-stage hormone-positive breast cancer is the standard of care. However, decisions based on genomic testing results are predicated on the assumption that patients receive endocrine treatment. We sought to investigate racial differences in genomic testing and adjuvant treatment in breast cancer.

Methods

A retrospective, population-based hospital registry study using the National Cancer Database. Participants included women with stages I–II, ER + breast cancer between 2010 and 2014. Sociodemographic factors were analyzed. Primary outcomes were the utilization of genomic testing and receipt of endocrine therapy. Logistic regression modeling was used to compute crude and adjusted odds of genomic testing and receipt of endocrine therapy.

Results

Among a total sample size of 387,008 patients, 147,863 (38.2%) underwent genomic testing. Older age (≥ 70 years) was associated with a lower adjusted odd of genomic testing (OR 0.33; 95% CI 0.32–0.34, p =  < 0.0001). Black patients had lower odds of receiving genomic testing on multivariate analysis compared to Whites (OR 0.82; 95% CI 0.80–0.85, p =  < 0.0001). In patients who underwent a genomic test, compared to Whites, Blacks had a lower odds of receiving endocrine therapy (OR 0.86; 95% CI 0.80–0.93, p =  < 0.0001) even if they did not receive adjuvant chemotherapy (OR 0.90; 95% CI 0.82–0.98, p = 0.014).

Conclusions

In a national sample of breast cancer patients, Black women are less likely to get genomic testing and receive hormonal therapy, even when adjuvant chemotherapy is omitted. A priority in addressing breast cancer disparities is to ensure adherence to hormonal therapy among all women, including those who do not receive adjuvant chemotherapy.

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Authors and Affiliations

  1. Section of Hematology and Oncology, Boston University School of Medicine, Boston Medical Center, 820 Harrison Ave, FGH Building, First Floor, Boston, MA, 02118, USA

    Naomi Y. Ko & Lauren Oshry

  2. Department of Radiation Oncology, Boston University School of Medicine, Boston Medical Center, Boston, USA

    Muhammad M. Qureshi, Oluwadamilola T. Oladeru, Minh-Tam Truong & Ariel E. Hirsch

  3. Harvard Radiation Oncology Program, Boston, MA, USA

    Oluwadamilola T. Oladeru

  4. Department of Surgery, Section of Surgical Oncology, Boston University School of Medicine, Boston, USA

    Michael R. Cassidy

Authors
  1. Naomi Y. Ko
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  2. Muhammad M. Qureshi
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  3. Oluwadamilola T. Oladeru
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  4. Michael R. Cassidy
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  5. Lauren Oshry
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  6. Minh-Tam Truong
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  7. Ariel E. Hirsch
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Contributions

Conception and design of manuscript: NYK, MMQ, MRC, LR, AEH; Collection and assembly of data: MMQ; Data analysis and interpretation: NYK, MMQ, OTO, MRC, LO, MTT, AEH; Manuscript writing: NYK, OTT; Final approval of this manuscript: NYK, MMQ, OTO, MRC, LO, MTT, AEH.

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Correspondence to Naomi Y. Ko.

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Conflict of interest

Naomi Ko has received speaker honoraria, consultant fees, and grants from Pfizer. Oluwadamilola Oladeru reported receiving grants from Partners Center of Expertise in Health Policy and Management and from the Radiation Oncology Institute, both outside the submitted work. All other authors declare no conflicts of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Ko, N.Y., Qureshi, M.M., Oladeru, O.T. et al. Racial differences in genomic testing and receipt of endocrine therapy in early-stage breast cancer. Breast Cancer Res Treat 184, 849–859 (2020). https://doi.org/10.1007/s10549-020-05888-9

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  • DOI: https://doi.org/10.1007/s10549-020-05888-9

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