Do Racial and Income Disparities Exist in the Application of 21-Gene Recurrence Score?

Area of Science:

• Oncology
• Genomics
• Health Services Research

Background:

• The 21-gene recurrence score aids in predicting recurrence risk for early-stage HR+/HER2- breast cancer.
• It helps identify patients who may benefit from chemotherapy, guiding treatment decisions.

Purpose of the Study:

• To assess disparities in the utilization of the 21-gene recurrence score based on race and income.
• To evaluate the impact of socioeconomic factors on access to this predictive genomic test.

Main Methods:

• Analysis of the SEER Medicare database (2012-2017) for HR+/HER2- breast cancer patients.
• Inclusion criteria: early-stage disease in postmenopausal women and Stage 1 in premenopausal women.
• Chi-square analysis was used to compare the application rates of the 21-gene recurrence score across different racial and income groups.

Main Results:

• Over 124,000 patients were included; 32.9% received 21-gene recurrence score testing.
• No clinically significant disparities in testing rates were observed between racial groups or income levels.
• Underuse was noted in older patients (≥65), widowed/divorced individuals, and those undergoing mastectomy compared to breast-conserving surgery.

Conclusions:

• Reassuringly, no significant racial or income disparities were found in the application of the 21-gene recurrence score.
• Opportunities exist to improve equity and guideline adherence, particularly for older patients, widowed/divorced individuals, and those undergoing mastectomy.
• The findings support de-escalation of chemotherapy based on genomic profiling in appropriate breast cancer patients.