Journal Article
. 2014 Jan;2013().
doi: 10.1155/2013/653805.

Utilization of Oncotype DX in an Inner City Population: Race or Place?

Amber A Guth 1 Susan Fineberg 2 Kezhen Fei 3 Rebeca Franco 3 Nina A Bickell 3 
  • PMID: 24455283
  •     6 References
  •     14 citations


Oncotype DX, a 21-gene-array analysis, can guide chemotherapy treatment decisions for women with ER+ tumors. Of 225 ER+ women participating in a patient assistance trial, 23% underwent Oncotype DX testing: 31% of whites, 21% of blacks, and 14% of Hispanics (P = 0.04) were tested. Only 3 white women were treated at municipal hospitals and none was tested. 3% of women treated in municipal hospital as compared to 30% treated at tertiary referral centers were tested (P = 0.001). Within tertiary referral centers, there was no racial difference in testing: 32% of whites, 29% of blacks, and 19% of Hispanics (P = 0.25). Multivariate analysis (model c-statistic = 0.76; P < 0.0001) revealed that women who underwent testing were more likely to have stage 1B (RR = 1.70; 95% CI: 1.45-1.85) and to be treated after 2007 (RR = 1.34; 95% CI: 1.01-1.65) and less likely to be treated at a municipal hospital (RR = 0.20; 95% CI: 0.04-0.94). Women treated at municipal hospitals were less likely to undergo testing resulting in a misleading racial disparity that is driven by site of care. As Oncotype DX can reduce overuse of chemotherapy, it is imperative to expand testing to those who could benefit from yet experience underuse of this test, namely, women treated at safety net hospitals. This trial is registered with NCT00233077.

Quality of breast cancer care: perception versus practice.
Nina A Bickell, Jennifer Neuman, +2 authors, Kathie-Ann Joseph.
J Clin Oncol, 2012 Apr 12; 30(15). PMID: 22493417    Free PMC article.
American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer.
Lyndsay Harris, Herbert Fritsche, +7 authors, American Society of Clinical Oncology.
J Clin Oncol, 2007 Oct 24; 25(33). PMID: 17954709
Highly Cited. Review.
Breast cancer racial disparities: unanswered questions.
Foluso O Ademuyiwa, Stephen B Edge, +3 authors, Willie Underwood.
Cancer Res, 2010 Dec 08; 71(3). PMID: 21135114
Primary care physicians who treat blacks and whites.
Peter B Bach, Hoangmai H Pham, +2 authors, J Lee Hargraves.
N Engl J Med, 2004 Aug 06; 351(6). PMID: 15295050
Highly Cited.
Economic evaluation of the 21-gene signature (Oncotype DX) in lymph node-negative/positive, hormone receptor-positive early-stage breast cancer based on Japanese validation study (JBCRG-TR03).
Masahide Kondo, Shu-Ling Hoshi, +2 authors, Masakazu Toi.
Breast Cancer Res Treat, 2010 Nov 18; 127(3). PMID: 21082239
Do community-based patient assistance programs affect the treatment and well-being of patients with breast cancer?
Nina A Bickell, Andrea N Geduld, +8 authors, Howard Leventhal.
J Oncol Pract, 2013 Sep 12; 10(1). PMID: 24023271    Free PMC article.
Patterns of 21-gene assay testing and chemotherapy use in black and white breast cancer patients.
Vanessa B Sheppard, Suzanne C O'Neill, +3 authors, Claudine Isaacs.
Clin Breast Cancer, 2015 Jan 04; 15(2). PMID: 25555816    Free PMC article.
Participation in Cancer Pharmacogenomic Studies: A Study of 8456 Patients Registered to Clinical Trials in the Cancer and Leukemia Group B (Alliance).
Lynn G Dressler, Allison M Deal, +5 authors, Howard L McLeod.
J Natl Cancer Inst, 2015 Jul 15; 107(10). PMID: 26160883    Free PMC article.
Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing.
Megan C Roberts, Morris Weinberger, +5 authors, Stephanie B Wheeler.
Breast Cancer Res Treat, 2015 Jul 29; 153(1). PMID: 26216535    Free PMC article.
Adoption of Gene Expression Profiling for Breast Cancer in US Oncology Practice for Women Younger Than 65 Years.
Suzanne C O'Neill, Claudine Isaacs, +8 authors, Arnold L Potosky.
J Natl Compr Canc Netw, 2015 Oct 21; 13(10). PMID: 26483061    Free PMC article.
Racial Variation in the Uptake of Oncotype DX Testing for Early-Stage Breast Cancer.
Megan C Roberts, Morris Weinberger, +5 authors, Stephanie B Wheeler.
J Clin Oncol, 2015 Nov 26; 34(2). PMID: 26598755    Free PMC article.
Implementation of the 21-gene recurrence score test in the United States in 2011.
Julie A Lynch, Brygida Berse, +5 authors, Andrew N Freedman.
Genet Med, 2016 Feb 19; 18(10). PMID: 26890451
Underutilization of gene expression profiling for early-stage breast cancer in California.
Rosemary D Cress, Yingjia S Chen, +2 authors, Kenneth W Kizer.
Cancer Causes Control, 2016 Apr 22; 27(6). PMID: 27097910    Free PMC article.
Utilization and impact of 21-gene recurrence score assay for breast cancer in clinical practice across the United States: lessons learned from the 2010 to 2012 National Cancer Data Base analysis.
Amila Orucevic, Robert E Heidel, John L Bell.
Breast Cancer Res Treat, 2016 May 22; 157(3). PMID: 27206678    Free PMC article.
Breast cancer multigene testing trends and impact on chemotherapy use.
G Thomas Ray, Jeanne Mandelblatt, +4 authors, Tracy A Lieu.
Am J Manag Care, 2016 Jun 09; 22(5). PMID: 27266581    Free PMC article.
Estimating the OncotypeDX score: validation of an inexpensive estimation tool.
Anne A Eaton, Catherine E Pesce, +5 authors, Mahmoud El-Tamer.
Breast Cancer Res Treat, 2016 Dec 09; 161(3). PMID: 27928699    Free PMC article.
Low utility of Oncotype DX® in the clinic.
Luisel J Ricks-Santi, John Tyson McDonald.
Cancer Med, 2017 Feb 02; 6(3). PMID: 28145091    Free PMC article.
Oncotype DX breast cancer recurrence score can be predicted with a novel nomogram using clinicopathologic data.
Amila Orucevic, John L Bell, Alison P McNabb, Robert E Heidel.
Breast Cancer Res Treat, 2017 Mar 01; 163(1). PMID: 28243897    Free PMC article.
21-Gene recurrence score testing among Medicare beneficiaries with breast cancer in 2010-2013.
Julie A Lynch, Brygida Berse, Nicole Coomer, John Kautter.
Genet Med, 2017 Mar 24; 19(10). PMID: 28333918
Racial Differences in 21-Gene Recurrence Scores Among Patients With Hormone Receptor-Positive, Node-Negative Breast Cancer.
Andreana N Holowatyj, Michele L Cote, +5 authors, Kristen S Purrington.
J Clin Oncol, 2018 Jan 18; 36(7). PMID: 29341832    Free PMC article.