title: Genomic testing and therapies for breast cancer in clinical practice.
abstract: OBJECTIVE
  Given the likely proliferation of targeted testing and treatment strategies for cancer, a better understanding of the utilization patterns of human epidermal growth factor receptor 2 (HER2) testing and trastuzumab and newer gene expression profiling (GEP) for risk stratification and chemotherapy decision making are important.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  We performed a medical record review of women aged 35 to 65 years diagnosed between 2006 and 2007 with invasive localized breast cancer, identified using claims from a large national health plan (N = 775).
  
  
  RESULTS
  Almost all women received HER2 testing (96.9%), and 24.9% of women with an accepted indication received GEP. Unexplained socioeconomic differences in GEP use were apparent after adjusting for age and clinical characteristics; specifically, GEP use increased with income. For example, those in the lowest income category (<$40,000) were less likely than those with an income of $125,000 or more to receive GEP (odds ratio, 0.34; 95% confidence interval, 0.16 to 0.73). A majority of women (57.7%) with HER2-positive disease received trastuzumab; among these women, differences in age and clinical characteristics were not apparent, although surprisingly, those in the lowest income category were more likely than those in the high-income category to receive trastuzumab (P = .02). Among women who did not have a positive HER2 test, 3.9% still received trastuzumab. Receipt of adjuvant chemotherapy increased as GEP score indicated greater risk of recurrence.
  
  
  CONCLUSIONS
  Identifying and eliminating unnecessary variation in the use of these expensive tests and treatments should be part of quality improvement and efficiency programs.
authors.affiliation: Division of General Medicine and Primary Care, Boston, MA 02120, USA. Jhaas@partners.org
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Phillips
authors.forename: Su-Ying
authors.initials: SY
authors.lastname: Liang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hassett
authors.forename: Carol
authors.initials: C
authors.lastname: Keohane
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
authors.forename: Joanne
authors.initials: J
authors.lastname: Armstrong
authors.forename: Michele
authors.initials: M
authors.lastname: Toscano
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics; D003430:Cross-Sectional Studies; D005260:Female; D018734:Genes, erbB-2 / Q000235:genetics; D005820:Genetic Testing; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D011320:Primary Health Care