Lower Oncotype DX Scores Seem Less Accurate for Black Women With Hormone Receptor-Positive Breast Cancer
Published on June 23, 2023
Among women diagnosed with early-stage, estrogen receptor-positive breast cancer, Black women with an Oncotype DX Recurrence Score of less than 26 had worse overall survival than women of other races and ethnicities with similar scores.
The research was presented on June 3, 2023, at the American Society of Clinical Oncology (ASCO) Annual Meeting. Read the abstract of “Racial/ethnic differences in 21-gene recurrence score and survival among estrogen receptor-positive breast cancer patients.”
Overall survival is how long a person lives, whether or not the cancer comes back (recurs).
About the Oncotype DX Breast Recurrence Score test
The Oncotype DX Breast Recurrence Score test is a genomic test that analyzes the activity of a group of 21 genes from a breast cancer tissue sample that can affect how a specific type of early-stage breast cancer is likely to behave and respond to treatment.
Doctors use the Oncotype DX Breast Recurrence Score test to help figure out a person’s risk of early-stage, estrogen receptor-positive, HER2-negative breast cancer coming back in a part of the body away from the breast (distant recurrence), as well as how likely a person is to benefit from chemotherapy to treat the cancer.
The Oncotype DX Breast Recurrence Score test results assign a Recurrence Score — a number between 0 and 100 — to the early-stage breast cancer. Based on your age, you and your doctor can use the following ranges to interpret your results.
For people older than 50 years of age:
Recurrence Score of 0 to 25: The cancer has a low risk of recurrence. The benefits of chemotherapy are not likely to outweigh the risks of side effects.
Recurrence Score of 26 to 100: The cancer has a high risk of recurrence. The benefits of chemotherapy are likely to be greater than the risks of side effects.
For people age 50 and younger:
Recurrence Score of 0 to 15: The cancer has a low risk of recurrence. The benefits of chemotherapy are not likely to outweigh the risks of side effects.
Recurrence Score of 16 to 20: The cancer has a low to medium risk of recurrence. The benefits of chemotherapy are not likely to outweigh the risks of side effects.
Recurrence Score of 21 to 25: The cancer has a medium risk of recurrence. The benefits of chemotherapy are likely to be greater than the risks of side effects.
Recurrence Score of 26 to 100: The cancer has a high risk of recurrence. The benefits of chemotherapy are likely to be greater than the risks of side effects.
Other research has shown that the information used to develop the Oncotype DX Breast Recurrence Score test came from studies where only about 5% to 6% of the women participating were Black.
“Increasing representation of racial and ethnic minorities is crucial to receiving detailed and specific results that indicate differences among populations,” Jasmin Gill, a sophomore at the University of Buffalo who presented the research, said in a statement. “With increased representation, we can further our understanding of prognostic tests such as the 21-gene recurrence score, with implications for further study and treatment of cancers in racial [and] ethnic minorities.”
About the study
The researchers analyzed information from 140,133 women diagnosed with early-stage, estrogen receptor-positive breast cancer between 2006 and 2018.
The information came from the National Cancer Database, a database with information on more than 70% of newly diagnosed cancer cases in the United States maintained by the American College of Surgeons and the American Cancer Society.
All the women had surgery to remove the cancer and took hormonal therapy after surgery. All the women also had Oncotype DX Breast Recurrence Score testing.
Among the women in the study:
115,651 were white (82.5%)
10,814 were Black (7.7%)
8,213 were Hispanic (5.9%)
5,455 were Asian or Pacific Islander (3.9%)
The researchers compared the Recurrence Scores and overall survival among the different racial and ethnic groups.
Half the women were followed for less than 66.2 months and half were followed for a longer period of time.
The researchers’ analysis found the following:
Black women were more likely to have a Recurrence Score of 26 or greater than white women, though their survival was similar to the survival of women of other racial and ethnic groups with similar scores.
Black women with a Recurrence Score of less than 26 had worse overall survival than white women with the same score.
Overall, Asian and Pacific Islander women had better overall survival than white women, regardless of their Recurrence Scores.
“This study highlights the importance of considering the whole patient and their oncologic factors in decision-making,” Anurag Singh, MD, director of radiation research and co-leader of the Cancer Stress Biology Program at the Roswell Park Comprehensive Cancer Center, said in a statement. Dr. Singh is the principal investigator of the study. “Our findings suggest that race should be reported and considered in the analysis of trials and large databases.”
What this means for you
Results from the RxPONDER study strongly suggested that post-menopausal women diagnosed with early-stage, hormone receptor-positive, HER2-negative breast cancer that had spread to one to three lymph nodes with a Recurrence Score of 25 or lower could skip chemotherapy.
The results of the study reviewed here suggest that Black women with a Recurrence Score of less than 26 have a higher risk of dying than white women with similar scores.
If you’re a Black woman diagnosed with early-stage, estrogen receptor-positive breast cancer and are deciding which genomic test to have after surgery, it makes sense to talk to your doctor about all the genomic tests you could have. The Oncotype DX Breast Recurrence Score test is just one genomic test available for early-stage breast cancer. The others are:
One of the other tests may be more appropriate to help you and your doctor make decisions about the best treatments — if any — for you after surgery.