Breast cancer multigene testing trends and impact on chemotherapy use

G. Thomas Ray, Jeanne Mandelblatt, Laurel A. Habel, Scott Ramsey, Lawrence H. Kushi, Yan Li, Tracy A. Lieu

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Objectives: A 21-gene test that predicts recurrence risk among women with hormone receptor positive (HR+), localized breast cancer was nationally recommended in 2007, but we know little about its subsequent impact. We evaluated: a) patient characteristics associated with test use, b) correlations between Recurrence Score (RS) and chemotherapy, and c) whether test introduction was associated with a reduction in chemotherapy use. Study Design: Retrospective cohort study. Methods: The Kaiser Permanente Northern California tumor registry and electronic health records from 2005 to 2012 were used to identify HR+, human epidermal growth factor receptor 2 negative, node-negative cancers. Analyses used logistic regression with propensity score matching and 2-level logistic regression. Results: Of the 7004 patients who met guidelines for testing, 22% were tested and 26% had chemotherapy. Test use was more likely in younger women (for ages 40-49 years vs 50-64 years: odds ratio [OR], 1.22; 95% CI, 1.04-1.44), in women with tumors sized 1.0 to 2.0 cm versus >2 cm (OR, 1.20; 95% CI, 1.03-1.40), and in women from higher-income neighborhoods (for each $10,000 increase in area median income: OR, 1.05; 95% CI, 1.03-1.07). Among patients with low RS, 8% had chemotherapy versus 72% among patients with high RS (P <.01). In propensity score-matched analyses, testing was associated with an absolute reduction of 6.2% in the proportion of women receiving chemotherapy (95% CI, 2.9%- 9.5%); the 2-level model showed a similar but nonsignificant (P = .14) association. Conclusions: The 21-gene test is used in a minority of eligible patients in this integrated plan. Its use appears to be associated with a modest decrease in overall chemotherapy use.

Original languageEnglish (US)
Pages (from-to)e153-e160
JournalAmerican Journal of Managed Care
Volume22
Issue number5
StatePublished - May 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Health Policy

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    Ray, G. T., Mandelblatt, J., Habel, L. A., Ramsey, S., Kushi, L. H., Li, Y., & Lieu, T. A. (2016). Breast cancer multigene testing trends and impact on chemotherapy use. American Journal of Managed Care, 22(5), e153-e160.