title: Patterns of 21-gene assay testing and chemotherapy use in black and white breast cancer patients.
abstract: BACKGROUND
  In women with early stage, hormone receptor (HR)-positive (HR(+)) breast cancer, the 21-gene recurrence score (RS) assay quantifies recurrence risk and predicts chemotherapy responsiveness. Recent data suggest that not all women with early-stage, HR(+) disease receive this testing. We examined sociodemographic, clinical, and attitudinal factors associated with RS testing receipt and the RS testing effect on chemotherapy use in black and white patients.
  
  
  METHODS
  Women with newly diagnosed invasive, nonmetastatic breast cancer were recruited and interviewed to collect sociocultural and health care process data; clinical data were collected from charts. Of the sample (n = 359), 270 had HR(+) disease. Primary analysis focused on those with HR(+) node-negative disease (n = 143); secondary analyses included node-positive women. Logistic regression models evaluated factors associated with receipt of RS testing and chemotherapy.
  
  
  RESULTS
  Among women eligible for the 21-gene assay, 62 patients [43%] received RS testing. In multivariable analysis, older age (odds ratio, 1.04 per 1 year increase; 95% confidence interval, 1.01-1.08) was associated with RS testing after adjustment for covariates. Chemotherapy use was 23%. In multivariable analysis, positive attitudes about chemotherapy and greater risk of recurrence were associated with chemotherapy use (P < .05).
  
  
  CONCLUSIONS
  Patterns of genomic testing might vary according to age. Efforts to understand factors associated with low testing rates will be important.
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC. Electronic address: vls3@georgetown.edu.
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Sheppard
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: O'Neill
authors.affiliation: Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Asma
authors.initials: A
authors.lastname: Dilawari
authors.affiliation: Department of Oncology, Howard University Hospital, Washington, DC.
authors.forename: Sara
authors.initials: S
authors.lastname: Horton
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC.
authors.forename: Fikru A
authors.initials: FA
authors.lastname: Hirpa
authors.affiliation: Breast Cancer Program, Lombardi Comprehensive Cancer Center and Departments of Oncology and Medicine, Georgetown University School of Medicine, Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Claudine
authors.initials: C
authors.lastname: Isaacs
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology / Q000628:therapy; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008875:Middle Aged; D012959:Socioeconomic Factors; D044465:White People
keywords: Adjuvant; Disparities; Genomic; Testing; Treatment