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Racial and ethnic disparities in 21-gene recurrence scores, chemotherapy, and survival among women with hormone receptor-positive, node-negative breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Cutoffs of the 21-gene recurrence score (RS), a commonly used genomic assay for hormone receptor-positive breast cancer, have been updated. Little is known about racial/ethnic differences in RS results, RS-guided chemotherapy use, and outcomes on updated cutoff (RS ≥ 31 defined as high-risk) in the real-world setting.

Methods

A total of 81,937 women [75.0% whites, 7.7% blacks, 8.3% Asian American/Pacific Islanders (AAPIs), and 9.0% Hispanics] diagnosed with hormone receptor-positive breast cancer between 2004 and 2015, who received the 21-gene assay, were identified from the Surveillance, Epidemiology, and End Results. Logistic regressions estimated the race-associated odds ratios (ORs) of RS and chemotherapy use. Cox regressions estimated the race-associated hazard ratios (HRs) of breast cancer-specific and all-cause mortality.

Results

Compared with white women, black women were more likely to have RS-defined high-risk tumors (adjusted OR [aOR] 1.29; 95% CI 1.16–1.42). In high RS, blacks had lower odds of chemotherapy use (aOR 0.76; 95% CI 0.62–0.94) than whites, particularly among women ≥ 65 years (aOR 0.51; 95% CI 0.35–0.76), while AAPI and Hispanic women had no variation in chemotherapy use compared with whites in high RS. Black women had a higher risk of breast cancer-specific mortality (HR 1.37; 95% CI 1.12–1.67) and all-cause mortality compared with white women after adjusting for demographic and pathological factors, county-level socioeconomic deprivation, treatments and RS; AAPIs had lower mortality and Hispanics had similar mortality.

Conclusions

Black women were more likely to have a high-risk RS tumor and less likely to receive chemotherapy in the group of high RS, especially those ≥ 65 years. Further studies are needed to identify barriers to chemotherapy in black patients with high RS scores.

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Data availability

The datasets analyzed during the current study are available Dr. Han on reasonable request.

Abbreviations

AAPI:

Asian Americans/Pacific Islander

CI:

Confidence interval

HER2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

NCCN:

National Comprehensive Cancer Network

OR:

Odds ratio

RS:

Recurrence score

RUCC:

Rural–urban continuum codes

SEER:

Surveillance, epidemiology, and end results

TAILORx:

Trial assigning individualized options for treatment

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Funding

Dr. Han is supported by the foundations from Barnes-Jewish Hospital and Breast Cancer Research Foundation. Dr. Peterson is supported by the American Cancer Society. Dr. Colditz is supported by the Breast Cancer Research Foundation and the Siteman Biostatistics Shared Resource P30 CA091842. Drs. Liu and Lian are supported by an American Cancer Society-Denim Days Research Scholar Grant (RSG-18-116-01-CPHPS) and the National Cancer Institute (R01CA215418). The funders had no role in design and conduct of the study, collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA

    Yunan Han, Graham A. Colditz & Ying Liu

  2. Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China

    Yunan Han

  3. Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Zhi-Feng Miao

  4. Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China

    Zhi-Feng Miao

  5. Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Min Lian

  6. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, 63110, USA

    Min Lian, Graham A. Colditz & Ying Liu

  7. Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Lindsay L. Peterson

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  1. Yunan Han
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Han, Y., Miao, ZF., Lian, M. et al. Racial and ethnic disparities in 21-gene recurrence scores, chemotherapy, and survival among women with hormone receptor-positive, node-negative breast cancer. Breast Cancer Res Treat 184, 915–925 (2020). https://doi.org/10.1007/s10549-020-05902-0

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