title: A study of the impact of the 21-gene breast cancer assay on the use of adjuvant chemotherapy in women with breast cancer in a Mexican public hospital.
abstract: BACKGROUND
  The majority of breast cancer patients in Mexico are treated through the public health system and >80% receive adjuvant chemotherapy. The aim of this prospective study was to characterize the impact of the Oncotype DX assay on adjuvant therapy decision making and the confidence in those decisions amongst public sector physicians in Mexico.
  
  
  METHODS
  Ninety-eight consecutive patients with ER+, HER2-, stage I-IIIa, N0/N1-3 node-positive breast cancer from the Instituto Nacional de Cancerología were eligible for the study. The primary endpoint was the overall change in treatment recommendations after receiving the assay results.
  
  
  RESULTS
  Of 96 patients, 48% received a chemohormonal therapy recommendation prior to testing. Following receipt of results, treatment decisions changed for 31/96 (32%) patients, including 17/62 (27%) node-negative patients and 14/34 (41%) node-positive patients. The proportion of patients with a chemotherapy-based recommendation decreased from 48% pre- to 34% post-assay (P=0.024). 92% of physicians agreed that they were more confident in their treatment recommendation after ordering the assay.
  
  
  CONCLUSIONS
  These results suggest that use of the 21-gene assay in the Mexican public health system has a meaningful impact on adjuvant treatment recommendations that may reduce the overall use of chemotherapy.
authors.affiliation: Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: Juan Enrique
authors.initials: JE
authors.lastname: Bargallo
authors.forename: Fernando
authors.initials: F
authors.lastname: Lara
authors.forename: Robin
authors.initials: R
authors.lastname: Shaw-Dulin
authors.forename: Victor
authors.initials: V
authors.lastname: Perez-Sánchez
authors.forename: Cynthia
authors.initials: C
authors.lastname: Villarreal-Garza
authors.forename: Hector
authors.initials: H
authors.lastname: Maldonado-Martinez
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mohar-Betancourt
authors.forename: Carl
authors.initials: C
authors.lastname: Yoshizawa
authors.forename: Emily
authors.initials: E
authors.lastname: Burke
authors.forename: Timothy
authors.initials: T
authors.lastname: Decker
authors.forename: Calvin
authors.initials: C
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000235:genetics* / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003657:Decision Making; D005260:Female; D020869:Gene Expression Profiling; D006779:Hospitals, Public; D006801:Humans; D008207:Lymphatic Metastasis; D008800:Mexico; D008875:Middle Aged; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000378:metabolism
chemical_list: D011960:Receptors, Estrogen
keywords: Oncotype DX; Recurrence Score; decision impact