title: Racial Variation in the Uptake of Oncotype DX Testing for Early-Stage Breast Cancer.
abstract: OBJECTIVE
  Oncotype DX (ODX) is a tumor gene-profiling test that aids in adjuvant chemotherapy decision-making. ODX has the potential to improve quality of care; however, if not equally accessible across racial groups, disparities in cancer care quality may persist or worsen. We examined racial disparities in ODX testing uptake.
  
  
  METHODS
  We used data from the Carolina Breast Cancer Study, phase III, a longitudinal, population-based study of 2,998 North Carolina women who received a diagnosis of breast cancer between 2008 and 2014. Our primary analysis used modified Poisson regression to determine the association between race and whether ODX testing was ordered among two strata: node-negative and node-positive breast cancer.
  
  
  RESULTS
  A total of 1,468 women with estrogen receptor-positive, human epidermal growth factor receptor-2-negative, stage I or II breast cancer met inclusion criteria. Black patients had higher-grade and larger tumors, more comorbidities, younger age at diagnosis, and lower socioeconomic status than non-black women. Overall, 42% of women had ODX test results in their pathology reports. Compared with those who did not receive ODX testing, women who received ODX testing tended to be younger and have medium tumor size and grade. Our regression analyses indicated no racial disparities in ODX uptake among node-negative patients. However, racial differences were detected among node-positive patients, with black patients being 46% less likely to receive ODX testing than non-black women (adjusted relative risk, 0.54; 95% CI, 0.35 to 0.84; P = .006).
  
  
  CONCLUSIONS
  We did not find racial disparities in ODX testing for node-negative patients for whom ODX testing is guideline recommended and widely covered by insurers. However, our findings suggest that a newer, non-guideline-concordant application of ODX testing for node-positive breast cancer was accessed less by black women than by non-black women, reflecting more guideline concordant care among black women.
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC. mclarker@unc.edu.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Roberts
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC.
authors.forename: Stacie B
authors.initials: SB
authors.lastname: Dusetzina
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC.
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Dinan
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Reeder-Hayes
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Troester
authors.affiliation: Megan C. Roberts, Morris Weinberger, Stacie B. Dusetzina, Katherine E. Reeder-Hayes, Lisa A. Carey, Melissa A. Troester, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill; Morris Weinberger, Durham Veterans Affairs Medical Center for Health Services Research; and Michaela A. Dinan, Duke Clinical Research Institute and Duke Cancer Institute, Durham, NC.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000737:chemistry / Q000208:ethnology* / Q000473:pathology*; D017322:Clinical Trials, Phase II as Topic; D015986:Confounding Factors, Epidemiologic; D066246:ErbB Receptors / Q000032:analysis; D005260:Female; D020869:Gene Expression Profiling / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008207:Lymphatic Metastasis; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D009657:North Carolina / Q000453:epidemiology; D016012:Poisson Distribution; D017410:Practice Guidelines as Topic; D057285:Precision Medicine / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: C512478:EGFR protein, human; D066246:ErbB Receptors