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. 2022 Apr 1;31(4):821-830.
doi: 10.1158/1055-9965.EPI-21-0929.

Oncotype DX Risk Recurrence Score and Total Mortality for Early-Stage Breast Cancer by Race/Ethnicity

Jaleesa Moore #  1 , Fei Wang #  1   2 , Tuya Pal  3 , Sonya Reid  4 , Hui Cai  1 , Christina E Bailey  5 , Wei Zheng  1 , Loren Lipworth  1 , Xiao-Ou Shu  1
Affiliations

Oncotype DX Risk Recurrence Score and Total Mortality for Early-Stage Breast Cancer by Race/Ethnicity

Jaleesa Moore et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: Oncotype DX recurrence score (ODX RS) is a prognostic biomarker for early-stage, node-negative, estrogen receptor-positive (ER+) breast cancer. Whether test uptake, associated factors, and the test's prognostic values differ by race/ethnicity is unknown.

Methods: From the National Cancer Database, 2010-2014, we identified 227,259 early-stage ER+, node-negative breast cancer cases. Logistic regression was used to examine ODX RS uptake and associated factors among non-Hispanic White (White), non-Hispanic Black (Black), Hispanic, and Asian American patients. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for overall mortality with ODX RS by race/ethnicity.

Results: White patients were more likely to receive an ODX RS test compared with Black, Hispanic, and Asian American patients (36.7%, 32.8%, 31.6%, and 35.5%, respectively; P < 0.001). Disparities persisted after adjustments for demographics, clinical characteristics, and access-to-care, with rate ratios of 0.87 (95% CI, 0.85-0.88), 0.82 (95% CI, 0.80-0.85), and 0.89 (95% CI, 0.87-0.92), respectively, for Black, Hispanic, and Asian American compared with White patients. Black patients had higher proportions of high-risk scores (≥26) compared with White, Hispanic, and Asian American patients (19.1%, 14.0%, 14.2%, and 15.6%, respectively; P < 0.0001). ODX RS was predictive for total mortality across all races/ethnicities, particularly younger patients (<50). No significant race/ethnicity interactions were observed.

Conclusions: Although ODX RS uptake and risk distribution varied by race/ethnicity, ODX RS was prognostic for mortality across groups.

Impact: These findings emphasize the importance of developing strategies to increase ODX RS uptake among racial/ethnic minorities and call for more investigations on potential racial/ethnic differences in breast cancer biology. See related commentary by Wang et al., p. 704.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Study Flowchart. Study data were drawn from the National Cancer Database (NCDB). Exclusion Criteria: no surgery, death within 90 days, metastatic breast cancer cases, race/ethnicity other than White, Black, Hispanic or Asian American. Inclusion Criteria: ER+ and HER2−, stage 1 or 2, regional node negative. Uptake analyses included all patients eligible to receive an ODX RS test.
See this image and copyright information in PMC

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References

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