Whitney E Zahnd1,2, Radhika Ranganathan3,4, Swann Arp Adams3,4,5, Oluwole A Babatunde6. 1. Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. whitney-zahnd@uiowa.edu. 2. Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA. whitney-zahnd@uiowa.edu. 3. Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. 4. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. 5. College of Nursing, University of South Carolina, Columbia, SC, USA. 6. Prisma Health, Greer, SC, USA.
Abstract
PURPOSE: Molecular testing is a critical component of breast cancer care used to identify the presence of estrogen and/or progesterone receptors (jointly hormone receptors-HRs) and the expression of human epidermal growth factor 2 (HER2) on a tumor. Our objective was to characterize trends and predictors of lack of molecular testing among female breast cancer patients overall and by sociodemographic characteristics. METHODS: We examined data on female breast cancer patients diagnosed between 2010 and 2016 from Surveillance Epidemiology and End Results-18. Joinpoint regression analyses assessed annual percent change (APC) in lack of ER, PR, or HER2 testing. Multivariable, multilevel logistic regression models identified factors associated with lack of molecular testing. RESULTS: A nominally lower proportion of rural patients did not receive molecular testing (e.g., 1.8% in rural vs. 2.3% in urban for HER2). For all tests, a higher proportion of Hispanic and non-Hispanic Black women were not tested. Across all characteristics, improvement in testing was noted, although disparities among groups remained. For example, lack of HER2 testing improved from 3.2 to 1.7% in White patients (APC = - 10.05) but was consistently higher in Black patients 3.9 to 2.3% (APC = - 8.21). Multivariable, multilevel models showed that older, non-Hispanic Black, and unpartnered women were at greater odds of not receiving molecular testing. CONCLUSIONS: While lack of molecular testing of breast cancer patients is relatively rare, racial/ethnic, insurance status, and age-related disparities have been identified. To reduce testing and downstream treatment and outcome disparities, it is imperative for all breast cancer patients to receive molecular testing.
PURPOSE: Molecular testing is a critical component of breast cancer care used to identify the presence of estrogen and/or progesterone receptors (jointly hormone receptors-HRs) and the expression of human epidermal growth factor 2 (HER2) on a tumor. Our objective was to characterize trends and predictors of lack of molecular testing among female breast cancer patients overall and by sociodemographic characteristics. METHODS: We examined data on female breast cancer patients diagnosed between 2010 and 2016 from Surveillance Epidemiology and End Results-18. Joinpoint regression analyses assessed annual percent change (APC) in lack of ER, PR, or HER2 testing. Multivariable, multilevel logistic regression models identified factors associated with lack of molecular testing. RESULTS: A nominally lower proportion of rural patients did not receive molecular testing (e.g., 1.8% in rural vs. 2.3% in urban for HER2). For all tests, a higher proportion of Hispanic and non-Hispanic Black women were not tested. Across all characteristics, improvement in testing was noted, although disparities among groups remained. For example, lack of HER2 testing improved from 3.2 to 1.7% in White patients (APC = - 10.05) but was consistently higher in Black patients 3.9 to 2.3% (APC = - 8.21). Multivariable, multilevel models showed that older, non-Hispanic Black, and unpartnered women were at greater odds of not receiving molecular testing. CONCLUSIONS: While lack of molecular testing of breast cancer patients is relatively rare, racial/ethnic, insurance status, and age-related disparities have been identified. To reduce testing and downstream treatment and outcome disparities, it is imperative for all breast cancer patients to receive molecular testing.
Authors: Swann Arp Adams; William M Butler; Jeanette Fulton; Sue P Heiney; Edith M Williams; Alexandria F Delage; Leepao Khang; James R Hebert Journal: Cancer Date: 2011-09-27 Impact factor: 6.860
Authors: Kimberly H Allison; M Elizabeth H Hammond; Mitchell Dowsett; Shannon E McKernin; Lisa A Carey; Patrick L Fitzgibbons; Daniel F Hayes; Sunil R Lakhani; Mariana Chavez-MacGregor; Jane Perlmutter; Charles M Perou; Meredith M Regan; David L Rimm; W Fraser Symmans; Emina E Torlakovic; Leticia Varella; Giuseppe Viale; Tracey F Weisberg; Lisa M McShane; Antonio C Wolff Journal: J Clin Oncol Date: 2020-01-13 Impact factor: 44.544
Authors: Edward H Romond; Edith A Perez; John Bryant; Vera J Suman; Charles E Geyer; Nancy E Davidson; Elizabeth Tan-Chiu; Silvana Martino; Soonmyung Paik; Peter A Kaufman; Sandra M Swain; Thomas M Pisansky; Louis Fehrenbacher; Leila A Kutteh; Victor G Vogel; Daniel W Visscher; Greg Yothers; Robert B Jenkins; Ann M Brown; Shaker R Dakhil; Eleftherios P Mamounas; Wilma L Lingle; Pamela M Klein; James N Ingle; Norman Wolmark Journal: N Engl J Med Date: 2005-10-20 Impact factor: 91.245
Authors: Antonio C Wolff; M Elizabeth Hale Hammond; Kimberly H Allison; Brittany E Harvey; Pamela B Mangu; John M S Bartlett; Michael Bilous; Ian O Ellis; Patrick Fitzgibbons; Wedad Hanna; Robert B Jenkins; Michael F Press; Patricia A Spears; Gail H Vance; Giuseppe Viale; Lisa M McShane; Mitchell Dowsett Journal: J Clin Oncol Date: 2018-05-30 Impact factor: 44.544
Authors: Oluwole Adeyemi Babatunde; Jan M Eberth; Tisha M Felder; Robert Moran; Chanita Hughes-Halbert; Samantha Truman; James R Hebert; Sue Heiney; Swann Arp Adams Journal: J Racial Ethn Health Disparities Date: 2021-01-11
Authors: Sue P Heiney; Samantha Truman; Oluwole A Babatunde; Tisha M Felder; Jan M Eberth; Elizabeth Crouch; Karen E Wickersham; Swann Arp Adams Journal: Am J Clin Oncol Date: 2020-07 Impact factor: 2.787