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

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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.

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Acknowledgments

The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, Contract HHSN261201000035C awarded to the University of Southern California, and Contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors would like to acknowledge and thank Rob Martinsen who conducted the data linkages for this study.

Funding

Dr. Cress and Dr. Chen were supported by the NCI Comprehensive Cancer Center Support Grant (P30CA93373). Funding for this project was provided by Grant from Genomic Health Inc. (Grant # 12-24512). Funder provided assay results but had no role in design and conduct of the study.

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Authors and Affiliations

  1. Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA

    Rosemary D. Cress & Yingjia S. Chen

  2. Cancer Registry of Greater California, Public Health Institute, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA

    Rosemary D. Cress

  3. California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health System, Sacramento, CA, USA

    Cyllene R. Morris & Kenneth W. Kizer

  4. Division of Hematology/Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA

    Helen Chew

  5. School of Medicine, University of California, Davis, Sacramento, CA, USA

    Kenneth W. Kizer

  6. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Kenneth W. Kizer

Authors
  1. Rosemary D. Cress
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  2. Yingjia S. Chen
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  3. Cyllene R. Morris
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  4. Helen Chew
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Correspondence to Rosemary D. Cress.

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Cress, R.D., Chen, Y.S., Morris, C.R. et al. Underutilization of gene expression profiling for early-stage breast cancer in California. Cancer Causes Control 27, 721–727 (2016). https://doi.org/10.1007/s10552-016-0743-4

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  • DOI: https://doi.org/10.1007/s10552-016-0743-4

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