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Treatment differences between urban and rural women with hormone receptor-positive early-stage breast cancer based on 21-gene assay recurrence score result
Background Women who live in rural and urban settings have different outcomes for breast cancer. A 21-gene assay predicts 10- year distant recurrence risk and potential benefit of chemotherapy for women with hormone receptor-positive (HR+) breast cancer.
Objective To assess differences in scores and cancer therapies received by rural versus urban residence.
Methods We conducted a multi-institutional retrospective chart review of breast cancer patients diagnosed 2005-2010 with score results. Comparisons by rural versus urban residence (determined by rural-urban commuting area (RUCA) codes derived from zip codes) were made using the Fisher exact test for discrete data such as recurrence score results (<18 vs >18; score range, 0-100, with lower results correlated with less risk of distant recurrence), stage, and receptor status. The Wilcoxon rank sum test was used for continuous data (score results 0-100 and age.) All tests were at a 2-sided significance level of .05.
Results 504 patients had RUCA codes (92% white, 62% postmenopausal). For rural (n = 135) compared with urban (n = 369) patients, the median scores were 16 and 18, respectively, P = .18. Most of the patients received endocrine therapy, 123 of 135 (91%) rural, compared with 339 of 369 (92%) urban (P = .19). For scores 18-30, 20 of 56 (36%) rural patients, compared with 82 of 159 (52%) urban patients received chemotherapy (P = .03).
Limitations Limitations include lack of randomization to receipt of the assay.
Conclusions Recurrence score results did not significantly differ between women based on residence, although women living in a rural area received significantly less chemotherapy for scores >18. This suggests that for HR-positive breast cancer, discrepancies between rural and urban residence are driven by treatment factors rather than differences in biology.
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Issue
The Journal of Community and Supportive Oncology - 13(5)
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Page Number
195-201
Legacy Keywords
hormone receptor-positive, HR, breast cancer, rural patients, urban patients, recurrence rates, chemotherapy
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Background Women who live in rural and urban settings have different outcomes for breast cancer. A 21-gene assay predicts 10- year distant recurrence risk and potential benefit of chemotherapy for women with hormone receptor-positive (HR+) breast cancer.
Objective To assess differences in scores and cancer therapies received by rural versus urban residence.
Methods We conducted a multi-institutional retrospective chart review of breast cancer patients diagnosed 2005-2010 with score results. Comparisons by rural versus urban residence (determined by rural-urban commuting area (RUCA) codes derived from zip codes) were made using the Fisher exact test for discrete data such as recurrence score results (<18 vs >18; score range, 0-100, with lower results correlated with less risk of distant recurrence), stage, and receptor status. The Wilcoxon rank sum test was used for continuous data (score results 0-100 and age.) All tests were at a 2-sided significance level of .05.
Results 504 patients had RUCA codes (92% white, 62% postmenopausal). For rural (n = 135) compared with urban (n = 369) patients, the median scores were 16 and 18, respectively, P = .18. Most of the patients received endocrine therapy, 123 of 135 (91%) rural, compared with 339 of 369 (92%) urban (P = .19). For scores 18-30, 20 of 56 (36%) rural patients, compared with 82 of 159 (52%) urban patients received chemotherapy (P = .03).
Limitations Limitations include lack of randomization to receipt of the assay.
Conclusions Recurrence score results did not significantly differ between women based on residence, although women living in a rural area received significantly less chemotherapy for scores >18. This suggests that for HR-positive breast cancer, discrepancies between rural and urban residence are driven by treatment factors rather than differences in biology.
Click on the PDF icon at the top of this introduction to read the full article.
Background Women who live in rural and urban settings have different outcomes for breast cancer. A 21-gene assay predicts 10- year distant recurrence risk and potential benefit of chemotherapy for women with hormone receptor-positive (HR+) breast cancer.
Objective To assess differences in scores and cancer therapies received by rural versus urban residence.
Methods We conducted a multi-institutional retrospective chart review of breast cancer patients diagnosed 2005-2010 with score results. Comparisons by rural versus urban residence (determined by rural-urban commuting area (RUCA) codes derived from zip codes) were made using the Fisher exact test for discrete data such as recurrence score results (<18 vs >18; score range, 0-100, with lower results correlated with less risk of distant recurrence), stage, and receptor status. The Wilcoxon rank sum test was used for continuous data (score results 0-100 and age.) All tests were at a 2-sided significance level of .05.
Results 504 patients had RUCA codes (92% white, 62% postmenopausal). For rural (n = 135) compared with urban (n = 369) patients, the median scores were 16 and 18, respectively, P = .18. Most of the patients received endocrine therapy, 123 of 135 (91%) rural, compared with 339 of 369 (92%) urban (P = .19). For scores 18-30, 20 of 56 (36%) rural patients, compared with 82 of 159 (52%) urban patients received chemotherapy (P = .03).
Limitations Limitations include lack of randomization to receipt of the assay.
Conclusions Recurrence score results did not significantly differ between women based on residence, although women living in a rural area received significantly less chemotherapy for scores >18. This suggests that for HR-positive breast cancer, discrepancies between rural and urban residence are driven by treatment factors rather than differences in biology.
Click on the PDF icon at the top of this introduction to read the full article.
Issue
The Journal of Community and Supportive Oncology - 13(5)
Issue
The Journal of Community and Supportive Oncology - 13(5)
Page Number
195-201
Page Number
195-201
Topics
Article Type
Display Headline
Treatment differences between urban and rural women with hormone receptor-positive early-stage breast cancer based on 21-gene assay recurrence score result
Display Headline
Treatment differences between urban and rural women with hormone receptor-positive early-stage breast cancer based on 21-gene assay recurrence score result
Legacy Keywords
hormone receptor-positive, HR, breast cancer, rural patients, urban patients, recurrence rates, chemotherapy
Legacy Keywords
hormone receptor-positive, HR, breast cancer, rural patients, urban patients, recurrence rates, chemotherapy
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JCSO 2015;13:195-201
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