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. 2020 Dec 15;126(24):5222-5229.
doi: 10.1002/cncr.33150. Epub 2020 Sep 14.

Genomic expression assay testing among American Indian and Alaska Native women with breast cancer

Schelomo Marmor  1 , Colleen F Longacre  2 , Ariella M Altman  1 , Jane Y C Hui  1 , Eric H Jensen  1 , Todd M Tuttle  1
Affiliations
Free article

Genomic expression assay testing among American Indian and Alaska Native women with breast cancer

Schelomo Marmor et al. Cancer. .
Free article

Abstract

Background: Breast cancer is one of the most common causes of cancer mortality for all women, including American Indian and Alaska Native (AI/AN) women. The use of the 21-gene recurrence score (RS) appears to be predictive of the benefit of chemotherapy for women with estrogen receptor (ER)-positive breast cancer. The objective of the current study was to compare RS testing between AI/AN and non-Hispanic White (NHW) women with breast cancer.

Methods: The Surveillance, Epidemiology, and End Results program was used to identify women with ER-positive breast cancer from 2004 through 2015. Multivariable logistic regression was used to evaluate factors associated with RS use, with high-risk RS, and with chemotherapy use among those with a high-risk RS.

Results: A total of 363,387 NHW patients and 1951 AI/AN patients with ER-positive breast cancer were identified. AI/AN women were found to be less likely to undergo RS testing and, when tested, were more likely to have a high-risk RS. In the multivariable logistic regression analysis, AI/AN women were found to be significantly more likely to have a high-risk RS (odds ratio,1.28; 95% confidence interval, 1.01-1.66). Among untested women, chemotherapy use was higher for AI/AN women; however, the use of chemotherapy was not found to be significantly different between the groups with a high-risk RS. Using Cox proportional hazards models, AI/AN race was found to be significantly associated with worse overall survival.

Conclusions: AI/AN women were less likely to undergo RS testing compared with NHW women and were more likely to have a high-risk RS. Reversing the disparity in genomic expression assay testing is critical to ensure guideline-based breast cancer treatment and improve survival rates for AI/AN women with breast cancer.

Keywords: 21-gene recurrence score; Alaska Native; American Indian; breast cancer; genomic expression assays; racial disparities.

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