Disparities in compliance with the Oncotype DX breast cancer test in the United States: A National Cancer Data Base assessment

Am J Surg. 2018 Apr;215(4):686-692. doi: 10.1016/j.amjsurg.2017.05.008. Epub 2017 Jun 14.

Abstract

Background: Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations were followed based on respective risk.

Methods: We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base.

Results: A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test. Non-testing rose with age. White patients were more likely to be tested (56%) versus black patients (46%, p < 0.0001). Testing was highest at academic facilities (40%). Privately insured patients were more likely to get the test compared to uninsured (45 versus 34%, p < 0.0001). Those in the highest income quartile were more likely to be tested (p < 0.001).

Conclusions: ODX is under-utilized, with racial and socio-economic factors influencing testing. Further studies are necessary to identify ways to remove disparities and increase testing when appropriate.

Keywords: Breast cancer; Compliance; Disparities; Oncotype DX.

MeSH terms

  • Aged
  • Biomarkers, Tumor
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / genetics*
  • Databases, Factual
  • Female
  • Gene Expression Profiling / statistics & numerical data*
  • Guideline Adherence*
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Middle Aged
  • Population Surveillance
  • Retrospective Studies
  • Socioeconomic Factors
  • United States

Substances

  • Biomarkers, Tumor