By Cara Rosner, Conn. Health I-Team Writer

A genetic test that helps doctors determine how best to treat breast cancer and whether chemotherapy is likely to help is significantly more likely to be administered to white women than blacks or Hispanics, a Yale University study has found.

The test, called Oncotype Dx, uses gene expression to gauge how early-stage breast cancer is affecting patients gene activity. It uses the information to determine how likely cancer recurrence would be, and physicians and their patients can use that knowledge to decide how to proceed with treatment.

Yale researchers analyzed a group of more than 8,000 Connecticut women who were diagnosed with hormone receptor positive breast cancer between 2011 and 2013, and found significant racial and ethnic disparities in use of this new gene test, said study leader Dr. Cary Gross, a member of Yale Cancer Center and professor of medicine and epidemiology at Yale School of Medicine.

It reinforces that, at the same time we are investing in developing new treatments and new testing strategies and were promoting them with great excitement, we really need to double-down our efforts to eliminate disparity, Gross said.

Breast test disparity

Here are some key statistics from a Yale University study about Oncotype Dx, a genetic test for breast cancer patients.

The study from that, among the Connecticut women for whom the test was recommended under national guidelines:

51.4 percent of white women received it

44.6 percent of black women received it and

47.7 percent of Hispanic women received it.

Among women for whom national guidelines did not recommend the test:

21.2 percent of white women received it

9 percent of black women received it and

9.7 percent of Hispanic women received it.

Among the Connecticut women for whom the test was recommended, Yale researchers found 51.4 percent of white women received it, compared with 44.6 percent of black women or 47.7 percent of Hispanic women.

One local doctor said the findings are disconcerting, but not surprising. Its long been known that women of color have lower rates of breast cancer screening, and are less likely to have mastectomies or breast reconstruction surgery, typically because they dont have access to or cant afford the services, said Dr. Denise Barajas, medical director of Griffin Hospitals Hewitt Center for Breast Wellness in Derby.

Research has also shown that minority women also are more likely to die from breast cancer.

This is just another area where were unfortunately seeing that certain groups dont have the same access, Barajas said.

Disparities found

The study also found disparity among women for whom national guidelines did not recommend the test. In that group, 21.2 percent of white women, 9 percent of black women and 9.7 percent of Hispanic women received it.

The findings were unsurprising not just to Barajas, but also to Dr. K. M. Steve Lo, a hematology oncologist and breast cancer expert at Stamford Hospitals Dorothy Bennett Cancer Center.

Its part of the overall problem with our health care system, Lo said. Minority women are less insured, underinsured, and have more out-of-pocket expenses to put out in one way or another. As a result, there will be less use of technology across the board. It needs to change but, unfortunately, I dont see a movement toward that in the near future. Its a systemic problem, and its a problem that we as a society need to address.

Barajas said that one of the most upsetting things about the Yale study, is that its first breast cancer-related disparity shes aware of involving a physician-led treatment. Mostly, Barajas said, its patients who opt not to have the treatment.

This test is offered by oncologists, for the most part," she said. Youd like to think that an oncologist would treat all women the same.

The only reason Barajas could think of for a woman who is eligible for the test not being offered it is that shes said she isnt interested in chemotherapy.

Removing guesswork

Having access to Oncotype Dx can greatly impact womens outcomes, Gross said. Even after a biopsy or tumor removal, he said, its still difficult to know which patients are at higher risk for their cancer coming back again. There are many, many subtypes of breast cancer. (The test) takes some of the guesswork out of it.

The test has become the standard of care for certain types of early-stage cancer, Lo said.

It helps physicians narrow down those women who really do benefit from treatments like chemotherapy, he said. That is crucial, he added, because it means many women who would not benefit from chemotherapy no longer are subjected to the process, the expense and the side effects.

Oncotype Dx is most frequently used on women who have stage 1 cancer that has not spread to the lymph nodes, Lo said, but its likely it will be used on women whose cancer has attached to lymph nodes.

In light of the studys findings, Gross team plans to examine data from a broader group of women to see why the disparities exist. Researchers will look at whether women are more or less likely to get the test depending on which hospital treats them, or whether there are disparities within hospitals.

Gross also said research should be done to determine if the tests $4,000 price tag though covered by many insurance companies is a barrier to some patients, and more breast cancer patients should be educated about national guidelines and recommendations.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org)

Hearst Connecticut Media staff writer Amanda Cuda contributed to this report.

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Women of color less likely to have breast cancer test - CT Post

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