Journal Article
. 2015 Aug;1(8).
doi: 10.1001/jamaoncol.2015.2722.

Association Between Use of the 21-Gene Recurrence Score Assay and Receipt of Chemotherapy Among Medicare Beneficiaries With Early-Stage Breast Cancer, 2005-2009

Michaela A Dinan 1 Xiaojuan Mi 2 Shelby D Reed 1 Gary H Lyman 3 Lesley H Curtis 4 
Affiliations
  • PMID: 26313372
  •     29 citations

Abstract

Importance: Guidelines recommend consideration of chemotherapy for most patients with early-stage, estrogen receptor-positive, invasive breast cancer in the absence of additional prognostic information. The 21-gene recurrence score (RS) assay has been shown in limited academic settings to reduce physician recommendations for adjuvant chemotherapy. Associations between the adoption of the assay and receipt of chemotherapy in the general population have not been examined.

Objective: To examine whether adoption of the RS assay in a nationally representative sample of patients with early-stage breast cancer was associated with use of chemotherapy.

Design, Setting, And Participants: Retrospective cohort study of Medicare beneficiaries who received a diagnosis of incident breast cancer between 2005 and 2009 using Surveillance, Epidemiology, and End Results data set with linked Medicare claims.

Main Outcomes And Measures: Receipt of chemotherapy within 12 months after diagnosis.

Results: A total of 44,044 patients had low-risk (24.0%), intermediate-risk (51.3%), or high-risk disease (24.6%, lymph node positive) as defined by National Comprehensive Cancer Network (NCCN) guidelines and met the study criteria. We observed no overall association between receipt of the RS assay and chemotherapy (odds ratio [OR], 1.03 [99% CI, 0.88-1.19]). In multivariable analysis, there was a significant interaction between NCCN risk and use of the RS assay, with assay use associated with lower chemotherapy use in high-risk patients (OR, 0.36 [99% CI, 0.26-0.50]) and greater chemotherapy use in low-risk patients (OR, 3.71 [99% CI, 2.30-5.98]), compared with no receipt of the assay (P=.006 for the overall interaction). Results were similar in prespecified subgroup analyses of patients 70 years and younger, with the exception of a shift toward lower chemotherapy use during 2008 (OR, 0.90 [99% CI, 0.77-.1.05]; P=.09) and 2009 (OR, 0.81 [99% CI, 0.66-0.99]; P=.007). In unadjusted analyses, overall chemotherapy use decreased over time in patients 70 years or younger with high-risk disease and those receiving the assay.

Conclusions And Relevance: The impact of the adoption of the RS assay on receipt of chemotherapy was strongly population dependent and was associated with relatively lower chemotherapy use in groups with high-risk disease and relatively higher chemotherapy use in patients with low-risk disease. Overall use of chemotherapy decreased during the study period in patients who were most likely to receive chemotherapy.

Chemotherapy and the recurrence score--results as expected?
Lajos Pusztai.
Nat Rev Clin Oncol, 2015 Nov 11; 12(12). PMID: 26552957
21-Gene Recurrence Score Assay As a Predictor of Adjuvant Chemotherapy Administration for Early-Stage Breast Cancer: An Analysis of Use, Therapeutic Implications, and Disparity Profile.
Jagar Jasem, Arya Amini, +4 authors, Peter Kabos.
J Clin Oncol, 2016 Mar 24; 34(17). PMID: 27001563    Free PMC article.
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.
21-Gene recurrence score decreases receipt of chemotherapy in ER+ early-stage breast cancer: an analysis of the NCDB 2010-2013.
Benjamin M Parsons, Jeffrey Landercasper, +3 authors, Leah L Dietrich.
Breast Cancer Res Treat, 2016 Aug 11; 159(2). PMID: 27507245    Free PMC article.
Breast carcinoma with an Oncotype Dx recurrence score <18: Rate of distant metastases in a large series with clinical follow-up.
Hannah Y Wen, Melissa Krystel-Whittemore, +7 authors, Edi Brogi.
Cancer, 2016 Aug 16; 123(1). PMID: 27526056    Free PMC article.
The Surveillance, Epidemiology, and End Results (SEER) Program and Pathology: Toward Strengthening the Critical Relationship.
Máire A Duggan, William F Anderson, +2 authors, Mark E Sherman.
Am J Surg Pathol, 2016 Oct 16; 40(12). PMID: 27740970    Free PMC article.
Highly Cited. Review.
Chemotherapy decisions and patient experience with the recurrence score assay for early-stage breast cancer.
Christopher R Friese, Yun Li, +6 authors, Steven J Katz.
Cancer, 2016 Oct 25; 123(1). PMID: 27775837    Free PMC article.
The influence of 21-gene recurrence score assay on chemotherapy use in a population-based sample of breast cancer patients.
Yun Li, Allison W Kurian, +6 authors, Timothy P Hofer.
Breast Cancer Res Treat, 2016 Dec 25; 161(3). PMID: 28012085    Free PMC article.
Oncologist and organizational factors associated with variation in breast cancer multigene testing.
Tracy A Lieu, G Thomas Ray, +8 authors, Jeanne S Mandelblatt.
Breast Cancer Res Treat, 2017 Feb 23; 163(1). PMID: 28224383    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
Endocrine therapy initiation, discontinuation and adherence and breast imaging among 21-gene recurrence score assay-eligible women under age 65.
Suzanne C O'Neill, Claudine Isaacs, +8 authors, Arnold L Potosky.
Breast Cancer Res, 2017 Apr 01; 19(1). PMID: 28359319    Free PMC article.
The 21-gene recurrence score in special histologic subtypes of breast cancer with favorable prognosis.
Gulisa Turashvili, Edi Brogi, +4 authors, Hannah Y Wen.
Breast Cancer Res Treat, 2017 Jun 04; 165(1). PMID: 28577081    Free PMC article.
21-Gene recurrence score and locoregional recurrence in lymph node-negative, estrogen receptor-positive breast cancer.
Gulisa Turashvili, Joanne F Chou, +5 authors, Hannah Y Wen.
Breast Cancer Res Treat, 2017 Jul 14; 166(1). PMID: 28702894    Free PMC article.
Treatment decisions and employment of breast cancer patients: Results of a population-based survey.
Reshma Jagsi, Paul H Abrahamse, +9 authors, Steven J Katz.
Cancer, 2017 Oct 11; 123(24). PMID: 28990155    Free PMC article.
Recent Trends in Chemotherapy Use and Oncologists' Treatment Recommendations for Early-Stage Breast Cancer.
Allison W Kurian, Irina Bondarenko, +7 authors, Steven J Katz.
J Natl Cancer Inst, 2017 Dec 14; 110(5). PMID: 29237009    Free PMC article.
Biomarkers in breast cancer: A consensus statement by the Spanish Society of Medical Oncology and the Spanish Society of Pathology.
R Colomer, I Aranda-López, +7 authors, J Palacios-Calvo.
Clin Transl Oncol, 2017 Dec 24; 20(7). PMID: 29273958    Free PMC article.
Review.
Breast carcinoma with 21-gene recurrence score lower than 18: rate of locoregional recurrence in a large series with clinical follow-up.
Gulisa Turashvili, Edi Brogi, +4 authors, Hannah Y Wen.
BMC Cancer, 2018 Jan 07; 18(1). PMID: 29304773    Free PMC article.
The 21-Gene Recurrence Score in Male Breast Cancer.
Gulisa Turashvili, Monica Gonzalez-Loperena, +4 authors, Hannah Y Wen.
Ann Surg Oncol, 2018 Mar 10; 25(6). PMID: 29520654    Free PMC article.
Cost-Effectiveness Analyses of the 21-Gene Assay in Breast Cancer: Systematic Review and Critical Appraisal.
Shi-Yi Wang, Weixiong Dang, +3 authors, Cary P Gross.
J Clin Oncol, 2018 Apr 17; 36(16). PMID: 29659329    Free PMC article.
Systematic Review.
Lymph Node Status in Breast Cancer Does Not Predict Tumor Biology.
Danielle M Bello, Christy Russell, +2 authors, Monica Morrow.
Ann Surg Oncol, 2018 Jul 04; 25(10). PMID: 29968028    Free PMC article.
Breast Cancers of Special Histologic Subtypes Are Biologically Diverse.
Audree B Tadros, Hannah Y Wen, Monica Morrow.
Ann Surg Oncol, 2018 Aug 11; 25(11). PMID: 30094484    Free PMC article.
A Value of Information Analysis of Research on the 21-Gene Assay for Breast Cancer Management.
Natalia R Kunst, Fernando Alarid-Escudero, A David Paltiel, Shi-Yi Wang.
Value Health, 2019 Sep 30; 22(10). PMID: 31563252    Free PMC article.
The 21-Gene Recurrence Score Assay and Prediction of Chemotherapy Benefit: A Propensity Score-Matched Analysis of the SEER Database.
In Sil Choi, Jiwoong Jung, +5 authors, Ki-Tae Hwang.
Cancers (Basel), 2020 Jul 12; 12(7). PMID: 32650374    Free PMC article.
Question Prompt List to Support Patient-Provider Communication in the Use of the 21-Gene Recurrence Test: Feasibility, Acceptability, and Outcomes.
Jinani Jayasekera, Susan T Vadaparampil, +8 authors, Suzanne C O'Neill.
JCO Oncol Pract, 2020 May 29; 16(10). PMID: 32463763    Free PMC article.
Patient and physician factors associated with Oncotype DX and adjuvant chemotherapy utilization for breast cancer patients in New Hampshire, 2010-2016.
Thomas M Schwedhelm, Judy R Rees, +4 authors, Erika L Moen.
BMC Cancer, 2020 Sep 05; 20(1). PMID: 32883270    Free PMC article.
The Changing Role of Gene-Expression Profiling in the Era of De-escalating Adjuvant Chemotherapy in Early-Stage Breast Cancer.
J E C van Steenhoven, A Kuijer, +5 authors, T van Dalen.
Ann Surg Oncol, 2019 Jun 19; 26(11). PMID: 31209664    Free PMC article.
Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar.
Suzanne C O'Neill, Susan T Vadaparampil, +9 authors, Susan Eggly.
Patient Educ Couns, 2020 Sep 10; 104(2). PMID: 32900604    Free PMC article.
Lymphovascular invasion, race, and the 21-gene recurrence score in early estrogen receptor-positive breast cancer.
Della Makower, Juan Lin, Xiaonan Xue, Joseph A Sparano.
NPJ Breast Cancer, 2021 Mar 03; 7(1). PMID: 33649322    Free PMC article.
SOX2 amplification and chromosome 3 gain significantly impact prognosis in esophageal squamous cell carcinoma.
Xin Wang, Xiaowen Ge, +9 authors, Yingyong Hou.
Ann Transl Med, 2021 Mar 13; 9(4). PMID: 33708948    Free PMC article.